New cases, including one death, in hepatitis A outbreak

As we’ve reported previously on Public Health Insider, King County has been investing heavily in work to prevent the spread of hepatitis A in King County. While our community has been fortunate in that to-date we have not experienced an outbreak on the scale seen in other large cities and states across the country, we have seen a recent increase in hepatitis A cases in King County, including one death associated with hepatitis A.

Hepatitis A cases in King County

Since January 1, 2019, a total of 49 King County residents infected with hepatitis A have been reported to Public Health, including 17 who became sick during November 24, 2019 to January 4, 2020. This is an increase compared to the previous six weeks (October 13, 2019 to November 23, 2019), during which we received reports of five King County residents who became sick with hepatitis A. Most of these infections have been in people who are living homeless or who use drugs.

For comparison, over the last decade, there have been 5–16 cases of hepatitis A reported in King County residents each year. In July 2019, Washington Department of Health declared a state-wide hepatitis A outbreak. The Washington Department of Health has had 154 cases of hepatitis A reported during April 1, 2019–January 3, 2020 statewide.

In December 2019, a King County man who had been living homeless died after being hospitalized with an acute hepatitis A infection complicating underlying chronic medical conditions. Hepatitis A infection is not typically life threatening. However, when people with underlying health conditions contract hepatitis A, their infection can result in more serious illness and complications.

“People who are living homeless or who are using drugs are more likely to have underlying health conditions that can be worsened by hepatitis A,” said Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County. “As a result, this community is particularly at-risk for developing serious and life-threatening illnesses if infected with hepatitis A. This community is also at higher risk for getting infected with hepatitis A in the first place. It’s for these reasons that we’re working to vaccinate as many people in this community as possible.”

More residents at high risk of infection are getting vaccinated every day with the goal of decreasing the risk that King County will experience the type of large-scale outbreaks seen elsewhere in the US.

People who get infected with hepatitis A can spread the virus to others up to two weeks before symptoms begin, and most people don’t develop symptoms until about a month after becoming infected. As a result, it can take a long time to identify new cases and intervene to prevent further spread.

Prevention efforts

The hepatitis A vaccine is the best way to prevent hepatitis A infection and to help mitigate a major outbreak. Having witnessed the large scale of hepatitis A outbreaks in other states, Public Health began holding free hepatitis A vaccination clinics for people living homeless starting in fall 2017, before we had identified any cases among people living homeless.

A Public Health nurse prepares supplies during a free hepatitis A vaccine clinic.

We increased this vaccination push in July 2019, when King County allocated $375,000 towards these efforts. In total, since January 2019, over 2,000 people have been vaccinated by Public Health and Public Health Reserve Corps staff at nearly 300 free vaccination clinics at shelters, day centers, villages and other sites serving people who are living homeless or using drugs. This outreach will continue in 2020, with hepatitis A vaccination clinics occurring nearly every day.

In addition, Public Health works closely with community partners, including the Hepatitis Education Project and other community clinics, who have provided nearly 5,000 hepatitis A vaccines in the last year, targeting people at high risk, including those who are unstably housed, people who use drugs, and men who have sex with men.

Public Health has also requested all healthcare emergency departments and primary care clinics in King County to screen patients for the risk factors of a history of homelessness or drug use and offer vaccination on the spot to prevent missed opportunities for protection against hepatitis A infection.  Men who have sex with men are also at increased risk for hepatitis A and should be vaccinated.

Hepatitis A in the state and the nation

For more information about Washington state’s hepatitis A outbreak, visit the Washington State Department of Health’s hepatitis A webpage.

Nationally, since the first hepatitis outbreaks were identified in 2016, according to the US Centers for Disease Control and Prevention, 30 states have reported a total of nearly 30,000 cases, including over 300 deaths.

About hepatitis A

Hepatitis A virus infects the liver and can cause illness that ranges from a mild infection with mild or no symptoms to a more severe illness that can last for months. Hepatitis A virus spreads easily. It gets into the body through the mouth after someone touches an object, food, or drink that is contaminated with the virus. If an infected person doesn’t wash their hands well, especially after using the toilet, undetectable amounts of the virus can spread from the hands of that person to other objects, surfaces, and foods.

Symptoms of hepatitis A

Common symptoms include tiredness, nausea, vomiting, abdominal pain, loss of appetite, low-grade fever, pale or clay-colored bowel movements and dark urine, joint pain and yellow discoloration of the whites of the eyes and skin (jaundice). Some people get infected with hepatitis A but do not experience all of these symptoms, or even have no symptoms.

People at highest risk for getting hepatitis A

People who are at highest risk are:

  • People living homeless, especially those living unsheltered without good access to sanitation, hygiene and handwashing facilities
  • People who have direct contact with a person who has hepatitis A, especially those who are living with or caring for a person with hepatitis A infection
  • Men who have sex with men
  • Illicit drug users (does not have to be injection drugs)
  • People with clotting disorders like hemophilia
  • International travelers
  • People with chronic liver disease, including hepatitis B and hepatitis C are at increased risk for severe infections.

Preventing hepatitis A
Hepatitis A vaccination is the best way to prevent hepatitis A. The shot is safe and effective; anyone who is in the higher risk groups should get the hepatitis A vaccine to protect themselves.  In addition, anyone who wants to reduce their risk of hepatitis A infection should get vaccinated.

To get a hepatitis A vaccine, visit your doctor, nurse, or clinic. You can also check for pharmacies that offer hepatitis A vaccine. For information about where to get free hepatitis A vaccine for people living homeless:

Practicing good hand hygiene also plays an important role in preventing the spread of hepatitis A, including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food. People in high risk groups should also avoid sharing food, drinks, drug paraphernalia, and other personal items.

For more information on hepatitis A: