Every year, hepatitis A is among the top ten most frequent problems our clients face. However, after seeing the number of outbreaks decline after the onset of COVID-19, we had hoped that the safety precautions that had been adopted at the start of the pandemic might help break the cycle. Now, we’re seeing signs that this is not the case.
While for years we had just a few outbreaks across our client base annually, beginning in 2017 that all changed. Just prior to COVID, we were managing four or more restaurant-related hepatitis A cases a week, then it stopped. Gloves, handwashing, reduced international travel to higher incidence areas and fewer people in the workplace seemed to reduce both hepatitis A and norovirus. However, in the last two months, there have been several hospitality-related cases in the news and our clients have, once again, had to navigate new outbreaks of hepatitis A among employees.
What is hepatitis A?
Hepatitis A is a vaccine-preventable, contagious liver disease. The most common symptoms of hepatitis A are yellow eyes and skin, and dark cola-colored urine. It can only be diagnosed through a blood test.
How do you get it?
Hepatitis A is transmitted by person-to-person contact or what’s referred to as the “fecal-oral route of transmission,” meaning that the hepatitis A virus is found in the stool of people who are infected and can survive on surfaces for several months. Infection can occur when someone ingests the virus, usually through close personal contact with an infected person. Drug use is a common risk factor for hepatitis A.
When was the last outbreak?
Prior to the arrival of COVID-19 in 2019, the U.S. was on the cusp of entering year three of the most significant outbreak on record since the hepatitis A vaccine was introduced in 1996. The first case connected with that outbreak, was in a homeless man in San Diego in November 2016. Officials declared an official outbreak in March 2017.
Since the person-to-person outbreaks were first identified in 2016, 35 states have reported more than 38,000 cases as of March 2021, requiring hospitalization for 61% of patients.
“The person-to-person hepatitis A outbreaks are ongoing, although it is difficult to interpret current data trends in the midst of the COVID-19 pandemic,” said Dr. Laura Cooley, medical epidemiologist, Hepatitis A Outbreak Response, Division of Viral Hepatitis at the CDC, via email. “Reaching people at highest risk for acquiring hepatitis A virus infection or developing serious complications — such as people who use drugs, people experiencing homelessness, and people who are incarcerated or detained — with hepatitis A vaccine, the mainstay of prevention, requires innovative approaches and partnerships beyond established clinical settings. CDC is assisting state and local health departments during these ongoing outbreaks and encourages them to stay vigilant to hepatitis A activity in their jurisdiction and to respond as they are able, even during this challenging time.”