Missouri state and local health officials issued a health advisory due to the hepatitis A outbreak in the southeast part of the state.

Image/Robert Herriman
Image/Robert Herriman

The Missouri Department of Health and Senior Services (DHSS) has reported 127 confirmed outbreak cases of hepatitis A virus infection since Sep. 2017.

Hepatitis A infection is a vaccine-preventable illness. The primary means of hepatitis A virus (HAV) transmission in the United States is typically person-to-person through the fecal-oral route (i.e., ingestion of something that has been contaminated with the feces of an infected person).

Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Although rare, atypical extra hepatic manifestations include rash, pancreatitis, renal disease, arthritis, and anemia.

Severe infections can result in cholestatic hepatitis, relapsing hepatitis, and fulminant hepatitis leading to death.

Average incubation of HAV is 28 days, but illness can occur up to 50 days after exposure.

Hepatitis A: CDC received 2,500 reports since 2017

The best way to prevent hepatitis A infection is through vaccination with the hepatitis A vaccine.

Health officials offer the following recommendations for health providers:

1. Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms.

2. Encourage persons who have been exposed recently to HAV and who have not been vaccinated to be administered one dose of single-antigen hepatitis A vaccine or immune globulin (IG) as soon as possible, within 2 weeks after exposure.

3. Ensure all persons diagnosed with hepatitis A are reported to the health department in a timely manner.

4. Encourage hepatitis A vaccination for persons who report drug use or other risk factors for hepatitis A.

5. CDC recommends the following groups be vaccinated against hepatitis A:

• All children at age 1 year

• Persons who are at increased risk for infection:

Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A;

Men who have sex with men;

Persons who use injection and non-injection drugs;

Persons who have occupational risk for infection;

Persons who have chronic liver disease;

Persons who have clotting-factor disorders;

Household members and other close personal contacts or adopted children newly arriving from countries with high or intermediate hepatitis A endemicity; and

Persons with direct contact with persons who have hepatitis A.

• Persons who are at increased risk for complications from hepatitis A, including people with chronic liver diseases, such as hepatitis B or hepatitis C.

• Any person wishing to obtain immunity.

Missouri officials investigate possible Bourbon virus case in St. Louis County