Back to School Amidst Hepatitis A Outbreaks

There is still no end in sight for the multiple hepatitis A outbreaks that are sweeping across the United States.

This week, a new outbreak was declared in the state of Massachusetts. According to health officials, there have been 65 cases of hepatitis A and 1 death reported since April. State ewpidemiologist, Catherine Brown, DVM, MSc, MPH, has indicated that so far, the cases are isolated in illicit drug users and homeless people.

While the threat to the public is low at this time, there have been a high number of cases reported in individuals who were previously exposed to hepatitis C, suggesting that this outbreak strain is stronger than the typical hepatitis A strain, according to Dr. Brown.

Outbreak cases are also being reported in Missouri, where 192 cases have been confirmed since September 2017. According to state health officials, injection and non-injection drug users are increasingly vulnerable to hepatitis A in this outbreak.

Although the majority of cases reported in the 11 outbreaks across the United States have been occurring in homeless populations and people who inject drugs (PWIDs), that is not always the case.

As children return to the classroom for the 2018-2019 school year, schools across the nation are advocating for the hepatitis A vaccination after being notified of cases of the virus infecting students.

In Hamilton Township, New Jersey, located near Contagion®’s home base, a letter was sent home to all parents in the district warning of 2 cases of hepatitis A that had been confirmed in students. The school district called on all parents to contact a health care provider to minimize their child’s risk of becoming infected with the virus. The district also offered free vaccines to children who were uninsured.

Hepatitis A is a cause for concern in young children because in many cases, no symptoms are experienced. The hepatitis A vaccine—an inactivated vaccine that requires 2 doses for long-lasting protection—was first recommended in the United States in 1996.

Since the vaccine has been recommended, the number of hepatitis A cases reported each year has dropped from 31,000 cases to about 1,500 cases per year, according to the Centers for Disease Control and Prevention (CDC).

However, the hepatitis A vaccine is required for entrance to Kindergarten in only 13 states and Washington D.C.

One state that recently changed immunization requirements to include a mandatory hepatitis A vaccination for school aged children is Kentucky.

Kentucky has the highest number of hepatitis A cases amongst the ongoing outbreaks, with 1,788 cases and 14 deaths reported as of September 15, 2018. According to the latest Acute Hepatitis A Outbreak Report, over 75% of the cases reported in the outbreak have occurred in homeless people and/or PWID; however, more than 20% of the ill have become infected with hepatitis A without having any known risk factors.

The majority of cases in Kentucky have been reported in individuals between the ages of 30 and 39 years; less than 50 cases have been reported in individuals 0 to 19 years. Despite the low number of cases in juvenile populations, Kentucky schools have been faced with hepatitis A cases in students as well.

As part of the mandatory hepatitis A vaccination requirement, students had until September 8, 2018 to receive their vaccinations.

In 1 particular school in the state, Anderson County High School, a student fell ill with hepatitis A in late August, prior to the vaccination deadline. In response, the school sent home letters to parents of the students that may have been in contact with the student to warn of potential exposure. The school also performed a “deep clean,” as recommended by health officials.

Earlier in September, another school district in Kentucky, Elliot County, closed the school after a case of hepatitis A was confirmed. School activities were cancelled as a thorough clean of the school was conducted.

The cases occurring in individuals who are not considered high-risk pose a serious threat. Not only because of the asymptomatic nature of hepatitis A infections in children, but also because the virus seems to be transmitted from person-to-person in this outbreak.

While required vaccinations are a good start to keep young people safe, new regulations have also delayed education for some children in Kentucky schools. According to an article from Anderson County, dozens of students were unable to attend school due to non-compliance with the vaccination requirements, weeks after the deadline.

These outbreaks raise a very important question: Should hepatitis A vaccinations be mandatory for school aged children in every state to keep all children safe and in school?

To stay up-to-date on the number of confirmed cases of hepatitis A in all outbreaks, be sure to check out the Contagion^® Outbreak Monitor.