State Reports Outbreak of Hepatitis A Among Homeless, Substance Abusers

Officials working with local health departments, providers to increase vaccination...

BOSTON - The Massachusetts Department of Public Health today announced that 65 Massachusetts residents experiencing homelessness and/or substance use disorder statewide have recently acquired acute hepatitis A infection, a viral infection that affects the liver and can cause severe illness. One person has died as a result of their infection.

DPH also today issued a public health alert about the hepatitis A outbreak, encouraging local health departments to work with clinical and community-based agencies providing services to people experiencing homelessness and those with substance use disorder, especially those injecting drugs, to educate them about the health risks and to offer vaccine. The Department will hold a call Wednesday with local boards of health officials.

Of the 65 hepatitis A cases, 45 percent are located in Boston with an increasing number in other cities and towns, including the Southeast and metro Boston areas. In early August, DPH and the Boston Public Health Commission issued a clinical advisory when it became apparent that there was ongoing transmission occurring among residents experiencing homelessness and/or substance use disorder. Most of those affected in Massachusetts and elsewhere also have evidence of hepatitis C, a blood-borne infection highly associated with injection drug use, making their illness more severe.

“We have seen a spike in cases of hepatitis A, with outbreaks being reported in at least 10 other states in similar populations, constituting thousands of cases nationwide,” said Public Health Commissioner Monica Bharel, MD, MPH. “As part of our statewide response here in Massachusetts, we are reaching out to all local health departments to encourage and assist their efforts to provide education and vaccinations for people at risk.”

“There may be misconceptions about the different types of hepatitis,” said Dr. Catherine Brown, state epidemiologist. “Hepatitis A infection can be prevented through vaccination and one dose of vaccine can provide substantial protection. It can also be prevented through proper hand washing, especially after using the toilet and before eating. There is no specific treatment for hepatitis A infection; most otherwise healthy people recover on their own.”

Hepatitis A is transmitted primarily through fecal-oral contact that can be associated with living in unsanitary conditions and poor hygiene. Symptoms include fever, fatigue, loss of appetite, stomach pain, nausea, diarrhea, and jaundice (yellowing of the skin and eyes), grey stools, and dark urine.

DPH has been working with clinicians statewide and local health departments, including the Boston Public Health Commission, to increase awareness of this outbreak among people who use substances and/or are experiencing homelessness and urging vaccination through homeless outreach services, shelters, community health centers, hospitals, and other facilities where these individuals seek care. 

For more information about hepatitis A, visit: https://www.mass.gov/service-details/hepatitis-a.

(See MDPH outbreak graph below)


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