Advisories

Date of advisory: Nov. 28, 2018

In Re:
REEMPHASIS OF HEPATITIS A VACCINATION RECOMMENDATIONS AFTER SUBSTANTIAL INCREASE IN LOCALLY ACQUIRED INFECTIONS IN FLORIDA AND OUTBREAK REPORTS ACROSS THE NATION

Pursuant to the authority granted in Section 381.00315, Florida Statutes, Celeste Philip, M.D., M.P.H., as State Surgeon General and State Health Officer, determines that a public health advisory is necessary to protect the public health and safety, and hereby issues the following Public Health Advisory.

Since January 2018, 385 cases of hepatitis A virus (HAV) infection have been reported in Florida. This is more than three times the previous five-year average of 126 cases. The increase in hepatitis A cases to date is predominantly in the Tampa Bay and Orlando metropolitan areas. Most of the cases do not involve international travel exposures. Although infections have occurred across all demographic groups, approximately 68% of the recent cases are among males. The median age of cases is 37 years and the highest rates of disease are among persons 30-49 years. Common risk factors include injection and non-injection drug use, homelessness, and men having sex with men (MSM).

Local and state health departments across the country have worked closely with the Centers for Disease Control and Prevention (CDC) to respond to similar outbreaks since March 2017. This year, health departments in Arkansas, California, Indiana, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Ohio, Tennessee, West Virginia and Utah, have investigated more than 8,000 outbreak associated cases of hepatitis A among persons who are homeless, persons who use drugs, men who have sex with men, and their close direct contacts.

HAV is transmitted person-to-person through fecal-oral route, which may include, but is not limited to, some types of sexual contact, and poor hand hygiene after going to the bathroom or changing diapers. HAV can also be spread through fecal-contaminated food or water. While most patients with HAV infections will fully recover, 77% of recent cases in Florida have required hospitalization.

The CDC Advisory Committee on Immunization Practices recommends that the following persons be vaccinated against HAV:

• All children at age 1 year
• Persons who are at increased risk for infection
• Persons who are at increased risk for complications from HAV
• Users of injection and non-injection drugs
• Persons who are homeless
• Men who have sex with men
• Persons who have chronic liver disease
• Persons traveling to or working in countries that have high or intermediate endemicity of HAV
• Persons who have clotting-factor disorders
• Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate HAV endemicity
• Persons having direct contact with persons who have HAV.

Health care providers are also reminded to immediately report all cases of hepatitis A to your county health department to ensure a prompt public health response in order to prevent disease among close contacts.

The Department of Health will continue to work closely with community partners to raise awareness and promote vaccination by:

• Providing education to persons who report drug use, homelessness and/or MSM activity.
• Encouraging proper hand hygiene and offering HAV vaccination.
• Collaborating with community partners associated with Federally Qualified Health Centers, local jails, drug treatment centers, homeless shelters, hospitals, the Florida Department of Children and Families, and managing entities, among others, to increase vaccination access to their clients.
• Providing all high-risk clients who present to county health departments for various services (including HIV, STD, TB) with the opportunity to receive HAV vaccination.
• Encouraging support of the CDC recommendations for Syringe Services Programs (SSP) to reduce new HAV infections by offering HAV vaccination to all high-risk clients who seek health care services at the SSP.
• Enhancing HAV and HAV vaccine information resources on the Department of Health’s webpage and developing audience-specific educational materials for clients and the public.
• Providing regular updates and messaging to the medical community.
• Continuing to work closely with the CDC to ensure Florida has sufficient vaccine and other resources for an effective response.

Issued this _28th_ day of       November      2018, in Department of Health offices, Tallahassee, Leon County, Florida.

Celeste Philip, MD, MPH
Surgeon General and Secretary

Link to the above advisory signed in PDF format

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