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Health Advisory: Hepatitis A Cases in People Living Homeless

April 30, 2019

Hepatitis A cases recently occurred in people living homeless in Washington. Large hepatitis A outbreaks are occurring in other areas of the country. Most cases are among people living homeless and/or using drugs. Pierce County currently does not have any cases.

Requested Actions

  • Give hepatitis A vaccine to unvaccinated patients living homeless and/or using drugs.
  • Suspect hepatitis A in patients—especially those living homeless and/or using drugs—with acute onset of jaundice, markedly elevated liver function tests or other symptoms of acute viral hepatitis.
  • Perform serologic testing on suspect cases—hepatitis A IgM or acute hepatitis panel.
  • Immediately report suspect cases to (253) 798-6410.


Hepatitis A can quickly spread from person to person in crowded conditions lacking sanitary facilities, like where people may live homeless. Hepatitis A causes higher rates of hospitalizations and deaths in people living homeless, likely due to comorbid conditions like chronic hepatitis B or C or alcohol-related cirrhosis.

Advisory Committee on Immunization Practices recently recommended routine hepatitis A immunization for people living homeless. One dose of hepatitis A vaccine offers very effective protection within 2 to 4 weeks. For full protection, a second dose is recommended 6 months later.

The virus spreads through infected feces. The incubation period is 2 to 6 weeks. People typically become ill 3 to 4 weeks after exposure. People are contagious 14 days before onset of jaundice until 7 days after onset. Infants and very young children typically show no symptoms but can spread the virus.

Household and close contacts should receive post-exposure prophylaxis with hepatitis A vaccine or immune globulin. Immediately report individual cases to (253) 798-6410 so we can coordinate post-exposure prophylaxis for close contacts as soon as possible.

The last case of hepatitis A in Pierce County occurred September 2018. Pierce County had 0 to 4 cases each year since 2011. In recent years, Washington typically has less than 50 cases each year. However, should a case occur in crowded conditions lacking sanitary facilities, it can quickly spread.

For more information, see our hepatitis information for healthcare providers page or call us at (253) 798-6410.


Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR / February 15, 2019 / 68(6);153–156.


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