Hepatitis A

 Summary:

Baltimore City is seeing a rise in hepatitis A virus cases. There are currently numerous hepatitis A outbreaks happening throughout the United States being spread through person-to-person contact.  Most cases have been among adults. The following groups are considered at highest risk for contracting the virus or developing serious complications and should be vaccinated: people experiencing homelessness or unstable housing, people who use drugs (injection or non-injection), gay and bisexual men, people who are, or were, recently incarcerated, and people with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C. 

Hepatitis A virus can cause liver damage and is preventable with the hepatitis A vaccine.  Since the multi-state hepatitis A outbreaks began in 2016, there have been more than 15,000 outbreak cases, over 8,500 (57%) hospitalizations, and 140 deaths. When individuals with hepatitis B and hepatitis C contract the hepatitis A virus, serious illness and in rare cases, liver failure or death is more likely to occur.  People with hepatitis B and hepatitis C need to get vaccinated for hepatitis A to prevent further damaging an already sick liver and developing potentially serious illness.

The Baltimore City Health Department (BCHD) is providing free hepatitis A vaccines to community partners who provide services to groups who are at highest risk of acquiring hepatitis A virus infection.  BCHD is conducting vaccine clinics at shelters, drop-in centers, syringe exchanges, and other venues that serve the at-risk populations.  BCHD has also launched a multi-media hepatitis A virus public awareness campaign.  The hepatitis A vaccine is available at BCHD clinics, mobile clinics, and outreach vans. Click here to find out where at-risk adults can get the hepatitis A vaccine.   

The BCHD is closely monitoring and working with our State and Federal partners. For more information, visit the Centers for Disease Control and Prevention's (CDC) website on Hepatitis A.

 
 

Overview

What is Hepatitis A?

Hepatitis A is a highly contagious infection of the liver caused by the hepatitis A virus.  Illness can be mild lasting several weeks to more severe lasting months and in rare cases, people have died. Hepatitis A can also cause liver failure and death. This is more common in people who are older than 50 and in people with other liver diseases.

Why should I care about Hepatitis A?

Hepatitis A virus can cause liver damage. Since 2016 over 20 states have been affected by hepatitis A outbreaks. Baltimore City is seeing a rise in Hepatitis A.  People affected by the recent Hepatitis A outbreaks have been more likely to be hospitalized, and in rare cases have died, compared to outbreaks in years past. This is not due to a more deadly strain, rather an exacerbation of liver injury on an already damaged liver. This includes people with chronic liver disease such as cirrhosis, hepatitis B and hepatitis C infections.

Transmission

How is the virus spread?

Hepatitis A virus replicates in the liver and is passed in the stool (feces). 

It is primarily spread person-to-person by the fecal-oral route - when someone unknowingly swallows small, even microscopic, amounts of stool from an infected person. This can happen when someone puts food, drink, or objects into their mouth that have been contaminated with the virus. This can also happen when someone has close contact with an infected person such as having sex, including oral or anal sex, taking care of someone who is ill or sharing drugs, including injection and non-injection drugs.  

How long does the virus live outside the body?

Depending on the surface the hepatitis A virus can live for months outside the body. Boiling or cooking foods or liquids at a high temperature (185°F or 85°C) for at least 1 minute will kill the virus. Freezing temperatures do not kill the virus. Also cleaning surfaces with a 1:100 dilution of household bleach to water can kill the virus. 

Symptoms

What are the symptoms?

Common symptoms for Hepatitis A include (but not limited to) the following:

HepASymtpoms_All

                 Adapted with permission from the County of San Diego Health, 3/29

Some people, especially children under six years old, may be contagious but not have any symptoms of the virus.

Does hepatitis A cause chronic infection, like Hepatitis B or Hepatitis C?

No, Hepatitis A is usually a short-term infection lasting weeks to months and does not become chronic.

Am I more likely to get sick if I already have Hepatitis B or Hepatitis C?

People with hepatitis B or hepatitis C are at greater risk of developing serious liver problems or in rare cases liver failure and death if they become infected with hepatitis A.  It is very important for people with hepatitis B or hepatitis C to get the hepatitis A vaccine. 

Can hepatitis A cause serious infection or death?

Illness can be mild lasting several weeks to more severe lasting months and in rare cases, people have developed liver failure and died.  People with existing liver disease are at a greater risk of becoming sick. 

Is it possible to get hepatitis A more than once?         

No, protection is lifelong. Once someone is either infected with the virus or receives the Hepatitis A vaccine, their body produces antibodies which protect them from becoming infected again in the future.  

Prevention

How can I protect myself?

  • Vaccination - The best way to protect yourself from Hepatitis A is to get vaccinated.  The vaccine is safe and effective – 95% effective after one dose, 100% after two doses. BCHD is offering free vaccines at the STD clinics and mobile vans for those who are at highest risk of infection.
  • Hand Hygiene - Wash your hands thoroughly for at least 20 seconds with warm, soapy water.  Perform hand hygiene before eating, drinking and preparing food, and after changing diapers, and going to the bathroom. Hand sanitizers do not kill the hepatitis A virus. Do not share towels, eating utensils, toothbrushes, cigarettes, or recreational drugs with an infected person.
  • Do not have sex with someone with hepatitis A – this includes anal-oral contact. Fingers/objects that have been in the anus of an infected person that make their way into the mouth pose a risk of acquiring the infection.

What is the hepatitis A vaccine?

The hepatitis A vaccine is an inactive (not live) form of the virus. It is considered to be safe and effective. The CDC recommends getting two doses of the vaccine 6 months apart.  One dose will protect you for 11 years and after completing the two-dose series protection is estimated to be 20 years or longer. If the second dose is delayed, longer than six months, you do not need to repeat the first dose but should administer the second dose as soon as possible. 

What are the side effects of the vaccine?

No serious side effects have been reported from the hepatitis A vaccine. The most commonly reported side effects of the vaccine for adults are soreness at the site of injection and headache. For children, the most commonly reported side effect is soreness at the injection site.

Who should get vaccinated?

The CDC’s recommends the routine vaccination of the following groups:

  • All children at age 1 year
  • People with direct contact with others who have hepatitis A infection
  • Gay and bisexual men*
  • Persons who use drugs (injection and non-injection)*
  • People experience homelessness or live in unstable housing*
  • Travelers to countries where hepatitis A is common
  • Family and caregivers of adoptees from countries where hepatitis A is common
  • People with chronic or long-term liver disease, including hepatitis B or hepatitis C*
  • People with clotting-factor disorders
  • Any person wishing to obtain immunity (protection)

*In addition to people who are or were recently incarcerated, BCHD is offering free vaccine to these groups to prevent and control a hepatitis A outbreak in Baltimore City.

What is the Baltimore City Health Department doing to prevent a hepatitis A virus outbreak?

  1. BCHD is providing free hepatitis A vaccines for adults who are at highest risk for infection: people experiencing homelessness, people who use drugs (injection and non-injection drugs), gay and bisexual men, and people recently incarcerated. More information on how to get vaccinated is below.
  2. Increasing public awareness of hepatitis A through a multi-faceted media campaign
  3. Engaging community partners who work with at-risk populations to provide education on transmission and prevention strategies
  4. Conducting hepatitis A information sessions for medical providers and staff working with at-risk populations 

Vaccination Clinics

Where can I get the Hepatitis A Vaccination?

The free hepatitis A vaccine for at-risk adults is available at the Baltimore City Health Department STD clinics and health department mobile vans.  The health department also employs a community health nurse who visits shelters, drop-in centers, and health department mobile clinics on a rotating basis. The following are places where you can get the free vaccine.

Clinic/Van

Address

Hours of Operation

Phone

Eastern Clinic*

620 N Caroline St

  • Mondays, Tuesdays, Wednesdays, and Fridays   from 9 AM to 4 PM
  • Thursdays from 9 AM to 12 PM

410-396-9410

Druid Clinic*

1515 W North Avenue

  • Mondays, Tuesdays, Wednesdays, and Fridays    from 9 AM to 4 PM
  • Thursdays from 9 AM to 12 PM

410-396-0176

SPOT Mobile Van

Various

Not available

Syringe Exchange Program

Various

Not available

*Patients are encouraged to arrive at the clinic at 8:30 a.m. as walk-in slots fill up quickly. If you are unable to arrive early in the morning and want to call ahead to see if slots remain open for the day, you are welcome to call the clinic’s front desk. However, we do not schedule these appointments over the phone.

 

Additional Information and Resources 

Centers for Disease Control and Prevention (CDC)

Maryland Department of Health (MDH)

Contact us for more information

If you would like to speak to someone about hepatitis A or the hepatitis A vaccine, please contact us: