Since March 2017, the U.S. Centers for Disease Control Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.
The hepatitis A vaccine is the best way to prevent HAV infection.
The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
People who use drugs (injection or non-injection)
People experiencing unstable housing or homelessness
Men who have sex with men (MSM)
People who are currently or were recently incarcerated
People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.1,2
Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.
CDC has provided outbreak-specific considerations for hepatitis A vaccine administration.
At A Glance
Since the outbreaks were first identified in 2016, 24 states have publicly reported the following as of June 21, 2019
Cases: 20,512
Hospitalizations: 11,776 (57%)
Deaths: 194
State-Reported Hepatitis A Outbreak Cases as of June 21, 2019
| State-Reported Hepatitis A Cases and Clinical Outcomes | |||||
| State | Case Total | Hospitalizations n (%) |
Deaths | Outbreak Start Date |
Data Current Through |
| Total | 20512 | 11776 (57%) | 194 | ||
| States with an ongoing outbreak | |||||
| Alabamaexternal icon | 84 | NR (NR) | NR | 9/1/2018 | 6/19/2019 |
| Arizonaexternal icon | 396 | 309 (78%) | 2 | 11/1/2018 | 6/20/2019 |
| Arkansasexternal icon | 343 | NR (NR) | NR | 2/7/2018 | 6/7/2019 |
| Coloradoexternal icon | 74 | 47 (64%) | 0 | 10/1/2018 | 6/19/2019 |
| Floridaexternal icon | 1876 | 1353 (72%) | 21 | 1/1/2018 | 5/31/2019 |
| Georgiaexternal icon | 437 | 292 (67%) | 1 | 6/1/2018 | 6/14/2019 |
| Idahoexternal icon | 26 | 14(54%) | 1 | 1/1/2019 | 6/20/2019 |
| Illinois external icon | 126 | 75(60%) | 0 | 9/1/2018 | 6/19/2019 |
| Indianaexternal icon | 1581 | 851 (54%) | 4 | 11/1/2017 | 6/21/2019 |
| Kentuckyexternal icon | 4715 | 2277 (48%) | 58 | 8/1/2017 | 6/8/2019 |
| Louisiana external icon | 302 | 178 (59%) | 1 | 1/1/2018 | 6/21/2019 |
| Massachusettsexternal icon | 363 | 298 (82%) | 5 | 4/1/2018 | 6/14/2019 |
| Michiganexternal icon | 916 | 735 (80%) | 28 | 8/1/2016 | 6/19/2019 |
| Missouriexternal icon | 323 | 163(50%) | 2 | 9/1/2017 | 6/19/2019 |
| New Hampshireexternal icon | 138 | 83 (60%) | 1 | 11/1/2018 | 6/18/2019 |
| New Mexicoexternal icon | 126 | 100 (79%) | 2 | 11/8/2018 | 6/20/2019 |
| North Carolinaexternal icon | 85 | 60 (71%) | 1 | 1/1/2018 | 6/17/2019 |
| Ohioexternal icon | 3070 | 1841 (60%) | 10 | 1/1/2018 | 6/17/2019 |
| South Carolinaexternal icon | 147 | 108 (73%) | 1 | 11/1/2018 | 6/14/2019 |
| Tennesseeexternal icon | 1791 | 1085 (60%) | 10 | 12/1/2017 | 6/21/2019 |
| Virginiaexternal icon | 71 | 45 (63%) | 0 | 1/1/2019 | 6/20/2019 |
| West Virginiaexternal icon | 2533 | 1249 (49%) | 23 | 3/19/2018 | 6/21/2019 |
| States with a declared end to their outbreak | |||||
| Californiaexternal icon | 708 | 464 (66%) | 21 | 11/1/2016 | 4/11/2018 |
| Utahexternal icon | 281 | 152 (54%) | 3 | 5/8/2017 | 2/12/2019 |
NR: not publicly reported
“Outbreak-associated” status is currently determined at the state level in accordance with each state’s respective outbreak case definition.
Outbreak-related hepatitis A deaths are defined at the state level in accordance with each state’s respective hepatitis A-related death definition. Some states are reviewing death certificates on a regular basis to actively find hepatitis A-related deaths, while other states are utilizing passive surveillance.
Outbreak start date is defined at the state level and may represent the earliest onset date of an outbreak case (AR, AZ, UT), the left censor date for which cases are considered part of the outbreak based on the state outbreak case definition (AL, CA, CO, FL, GA, ID, IL, IN, KY, LA, MA, MI, MO, NC, NH, OH, SC, TN, VA), or when a state declared a hepatitis A outbreak (NM, WV).
CDC’s Response
In response to all hepatitis outbreaks, CDC provides ongoing epidemiology and laboratory support as well as support on vaccine supply and vaccine policy development. When requested, CDC sends “disease detectives” to affected areas to evaluate and assist in an outbreak response. CDC alerts other public health jurisdictions of any increases in disease. All jurisdictions are encouraged to be watchful for increases in hepatitis A cases. CDC also works with state and local health officials to ensure hepatitis A vaccine is targeted to the correct at-risk populations and that supply is adequate.
Postexposure Prophylaxis
Postexposure 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:
Hepatitis A vaccine for people aged ≥12 months
Hepatitis A virus-specific immunoglobulin (IG) for specific populations
PEP Recommendations:
NOTE: CDC recommends that all children be vaccinated against hepatitis A at age 1 year. Parents or caregivers who are unsure if a child has been vaccinated should consult the child’s health-care provider to confirm vaccination status.
HAV Specimen Requests
State health departments wanting to submit specimens must contact CDC at hepaoutbreaklab@cdc.gov for approval before shipping specimens to CDC. Only specimens that that have tested positive for anti-hepatitis A IgM and meet any of the following criteria will be considered.
Specimen from a case patient in a county that has not yet reported a hepatitis A case in an at-risk population;
Specimen from a case patient who doesn’t report any known risk factors or contact with at-risk populations (e.g., household or sexual contact, volunteering at a homeless shelter);
Specimen from a case patient suspected to be associated with foodborne transmission;
Archived/stored specimen from a patient who has died, and whose classification as an outbreak-related death requires nucleic acid testing beyond anti-HAV IgM-positivity; or
Other patient specimens not meeting the above criteria that require nucleic acid testing or molecular characterization (to be discussed on a case-by-case basis).
Dear Colleague Letter pdf icon[PDF – 6 MB] from CDC Division of Viral Hepatitis Director regarding Submission of Patient Specimens to CDC for Hepatitis A Testing.
Additional Vaccination Information
Outbreak-specific considerations for hepatitis A vaccine administration
MMWR – The dose of GamaSTAN™ S/D has recently been changed
Current Vaccine Shortages & Delays – Information on Vaccine Supply
For Immunization Managers – Information on Vaccines Purchased with 317 Funds
Professional Resources
Medscape Commentary: Hepatitis A: Breaking Out All Overexternal icon
Archived webinar: Preventing and Controlling Hepatitis A in Jails and Prisons from the National Institute of Corrections, BOP and CDCexternal icon
HAN: Update: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States – March 2019
COCA Call On-Demand Webinar for Clinicians: Hepatitis A Outbreaks in Multiple States – CDC Recommendations and Guidance – Nov. 2018
HAN: Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness– June 2018
Posters on how to clean up and disinfect to help prevent spread of hepatitis A virusexternal icon from Water Quality & Health Council
Updated CSTE clinical case definition for acute viral hepatitis A
CDC guidance on viral hepatitis surveillance and case management
CDC training on hepatitis A serology
Hepatitis A general FAQs for Health Professionals
Educational Resources
CDC is developing educational materials to support the outbreak at the state and local levels. Most materials include an area where local information can be inserted. Your organization’s contact information can be typed into the blue colored rectangle. To upload your logo, click on the white space below the blue colored rectangle. In the pop-up box, select browse and upload a PDF version of your logo.
Fact Sheets
One page visual fact sheets encouraging vaccination for:
people who use drugs pdf icon[PDF – 244 KB]
gay and bisexual men pdf icon[PDF – 332 KB]
people experiencing unstable housing or homelessness pdf icon[PDF – 282 KB]
people who are or were recently in jail or prison pdf icon[PDF – 282 KB]
Two page visual fact sheet pdf icon[PDF – 615 KB] that includes information on hepatitis A prevention, transmission, symptoms and encourages multiple populations to get vaccinated
Pocket Cards
Outbreak of hepatitis A Pocket Card pdf icon[PDF – 786 KB] to localize with organization information and outlines who should get vaccinated and the symptoms of hepatitis A
Printing Instructions: These cards should be printed double-sided on 4.25” x 5.5” perforated postcard templates that print four double-sided cards per page. The print settings must be set to “Actual size” or “Custom Scale 100%” to ensure accurate alignment of the two sides of the cards.
Get Vaccinated Pocket Card pdf icon[PDF – 455 KB] to localize with information where to go to get the vaccine and who should get vaccinated
If You’re Sick Pocket Card pdf icon[PDF – 470 KB] to localize with information on where to go for medical care and the symptoms of hepatitis A
Pocket Card Printing Instructions: These cards should be printed double-sided on business card templates that print six double-sided cards per page. The print settings must be set to “Actual size” or “Custom Scale 100%” to ensure accurate alignment of the two sides of the cards.