While so much attention has been on the hepatitis A outbreaks in California and Michigan, for good reason, not much attention has been given to the third largest outbreak in the United States—Utah.

Image/ National Atlas of the United States
Image/ National Atlas of the United States

California, particularly the San Diego area and southeast Michigan, including Detroit have accounted for more than 1100 cases, 800 hospitalizations and 40 deaths.

Out west in the Beehive State, since January 1, 2017, Utah public health has identified 84 confirmed cases of hepatitis A virus (HAV) infection (75 outbreak-associated cases); many among persons who are homeless and/or using illicit drugs. About three-quarter of the cases have been reported in Salt Lake County and more than half required hospitalization.

“Our greatest concern with the outbreak is that it will leap into another population, or into the general population, and the outbreak will grow exponentially,” said Nicholas Rupp, a spokesman for the Salt Lake County Health Department.

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The high rate of hospitalization may be a result of cases having underlying illnesses (e.g., alcoholism), or a higher rate of hepatitis comorbidities (e.g., hepatitis B or C). No deaths have been reported in Utah.

Several cases have been linked by investigation and/or viral sequencing to a national outbreak of hepatitis A involving cases in California and Arizona.

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For the current U.S. outbreaks among people who are homeless and/or people who use injection and non-injection drugs, CDC has encouraged state and local health departments to:

  • Work with community partners to provide hepatitis A vaccine to people who are homeless, people who use injection and non-injection drugs, and others with established risk factors who are not yet immunized
  • Consider hepatitis A vaccination for anyone with ongoing, close contact with people who are homeless or people who use injection and non-injection drugs

CDC has provided interim outbreak-specific guidance on hepatitis A vaccine administration.

Post exposure prophylaxis (PEP) is recommended for unvaccinated people who have been exposed to hepatitis A virus (HAV) in the last 2 weeks; those with evidence of previous vaccination do not require PEP.

PEP consists of: