- Health care providers, particularly hospital emergency departments and urgent care centers, should offer hepatitis A vaccines to all patients who are homeless, users of injection or non-injection illicit drugs, infected with hepatitis B or hepatitis C, or have other liver disease, e.g., alcoholic cirrhosis.
- Serologic screening for immunity before vaccination is not necessary; however, prior doses of the vaccine may be recorded in the Washington State Immunization Information System (WA IIS).
- Where feasible and appropriate, use standing orders/order sets to ensure vaccination of the atrisk population.
- Record vaccine doses administered in your EMR or WA IIS.
- Ensure all vaccines are stored and handled appropriately.
- Hospitals should also:
- Offer hepatitis A vaccine to health care personnel who have frequent close contact with patients who are homeless and/or use injection or non-injection illicit drugs.
- Ensure appropriate cleaning of restrooms frequented by persons who are homeless and/or use injection or non-injection illicit drugs, using methods similar to those for norovirus.
- Among suspected cases of hepatitis A (e.g., anorexia, nausea, fatigue, jaundice):
- Submit serum for anti-HAV IgM;
- Notify the SHD Communicable Disease Program at 425.339.5278
- Impose enteric precautions until seven days after onset of jaundice.
- Offer hepatitis A vaccine to previously unimmunized close contacts.
- Four cases of hepatitis A have been reported in Snohomish County residents during the past week.
- All have been experiencing homelessness and/or injecting drugs.
- These cases have centered around the Marysville-Tulalip area.
- Although molecular confirmation of linkage to the statewide outbreak is pending, the cases’ features are consistent with that profile (i.e., homelessness and/or drug injection).
Additional information about the vaccine
- One dose of single-antigen hepatitis A vaccine provides better protection than one dose of combined hepatitis A/hepatitis B (Twinrix®) vaccine. For this reason, only single-antigen hepatitis A vaccine should be used for post-exposure prophylaxis.
- Providers should consider short-term risks of exposure to HAV, the likelihood of follow-up to complete multi-dose immunization and the need for protection from hepatitis B when selecting vaccines for those at risk. Do not delay vaccination to obtain a different formulation of vaccine if Twinrix is not available.
- Persons who have been exposed to HAV in the prior 2 weeks who are not known to be immune should receive single-antigen hepatitis A vaccine and/or immune globulin.
- Persons injecting drugs who are not known to be immune should also receive a full hepatitis B series.
- Dr. Chris Spitters, Interim Health Officer Snohomish Health District