Hepatitis A Health Alert

Please click below to view the official announcement from USC’s Environmental Health and Safety Department regarding the Hepatitis A Health alert. The Hepatitis A vaccines is available at Eric Cohen for $77.00. If you have any questions or would like to make an appointment, please call Eric Cohen at 323-442-5631.

Hepatitis A Health Alert

Letter from the Eric Cohen Student Health Center Medical Director:

Dear HSC Student,

In response to the recent increase in Hepatitis A cases in Southern California, we would like to remind you of the importance of prevention. Per CDC and CDPH guidelines, the most effective method in preventing the spread of contagious diseases is proper handwashing and vaccination. As this vaccine has been available since the late 1990s, many students may have already received the Hepatitis A vaccine as a child.

Hepatitis A vaccination is available to all HSC students (by appointment with our Support Staff) and is billable with the Aetna Student Health Insurance Plan. Otherwise, for students covered by other health insurances, it would be more cost effective for them to see their PMD. For the students who would prefer to pay out-of-pocket, we only charge $77.00 right now: https://ecohenshc.usc.edu/procedures-vaccination-and-lab-draw-fees/

I have pasted some web links for your reference and we have added the attached flyer in our website:
Information about Hepatitis A: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Hepatitis-A-(Foodborne).aspx 
Information about Hepatitis A vaccine: https://www.cdc.gov/vaccines/vpd/hepa/index.html

Kimberly Tilley, M.D.
Medical Director



LAC DPH Health Alert: Increase in Hepatitis A among Men Who Have Sex with Men (MSM) in Los Angeles County

November 2, 2017

Key Messages

  • An increased number of cases of hepatitis A virus (HAV) is occurring among men who have sex with men (MSM) in Los Angeles County in 2017 compared with 2016.
  • This increase is occurring in the context of an outbreak of hepatitis A in LA County among persons who are homeless or use illicit (injection and non-injection) drugs.
  • All MSM should be offered HAV vaccination. Vaccination is the best method for preventing HAV infection.
  • The combined HAV/hepatitis B (HBV) vaccine (Twinrix), should be used for MSM as supplies of the single antigen HAV vaccines (Havrix and Vaqta) are constrained.
  • Providers are encouraged to attend the live LAC DPH webinar on HAV with Q&A occurring on Wednesday, November 8 at 12 pm. Free CME is available. Register here to participate.

Current Situation
In 2017 to date, 12 HAV cases have been confirmed among MSM who are neither homeless nor actively use drugs; several additional cases are pending further investigation. In comparison, a total of 9 HAV confirmed cases were reported in MSM in all of 2016. This increase has occurred coincident with several large outbreaks of HAV in the U.S. and internationally. Since the beginning of the year, almost 6,000 cases of HAV in MSM have been reported in 14 European countries and over 700 in Chile. In the U.S., HAV outbreaks in MSM have been identified in New York City and Colorado.
This increase of HAV cases among MSM in LA County is being noted at a time when there are outbreaks of HAV among homeless persons and those using illicit drugs in several California counties, including LA County. As of October 30, 2017, fourteen outbreak-associated HAV cases among persons who are homeless or use illicit drugs have been reported in LA County. San Diego County has experienced the largest number with over 600 reported cases.
MSM are recognized to be at higher risk for infection with HAV. The U.S. Centers for Disease Control and Prevention (CDC) recommends HAV vaccination for all MSM. HAV is usually transmitted by the fecal-oral route (either via person-to-person contact or consumption of contaminated food or water). Risk factors for HAV transmission include household or sexual contact with another person with hepatitis A, residence in or travel to areas with poor sanitation, as well as illicit drug use.
Currently, the U.S. supply of single antigen HAV vaccines (Havrix and Vaqta) are constrained as a result of multiple global HAV outbreaks. However, the combined HAV/HBV vaccine (Twinrix) is more available and is effective. LAC DPH currently encourages the use of HAV/HBV vaccine for the vaccination of MSM. The combined vaccine may also be used for other individuals at risk for hepatitis A infection when single antigen vaccine is not available. Immunity to hepatitis A following a single dose of HAV/HBV vaccine is slightly less than with single antigen vaccine (91% vs 98% of adults). It is safe to administer the HAV/HBV vaccine to persons who have previously completed the 3-dose HBV vaccination series. LAC DPH recommends deferring the follow-up doses of a HAV vaccination series for immunocompetent individuals until vaccine supply constraints resolve. Immunocompromised individuals should complete the vaccination series.

Actions Requested of Providers

  • Vaccinate individuals at increased risk for HAV or its consequences including MSM, persons who are homeless and/or who use illicit drugs, and those with chronic liver disease or HIV infection.
  • Consider prescreening for hepatitis A immunity in patients who can be expected to follow-up for vaccination. Due to current vaccine constraints, providers may consider offering testing for anti-hepatitis A virus IgG to patients lacking documentation of vaccination as they may already be immune. If there are any concerns about follow-up, the patient should be vaccinated without delaying for antibody testing.
  • Vaccinate MSM patients against other pathogens currently causing outbreaks in LA County. Vaccines should be administered as recommended in previous LAHAN health alerts to prevent meningococcal disease and mumps.
  • Immediately report all suspect and confirmed HAV cases to the LAC DPH Morbidity Unit by calling 888-397-3993. After hours call 213-974-1234. Suspect HAV cases in patients who are homeless or who use drugs should be reported while the patient is still at the facility as per the recent HAV outbreak LAHAN.

Diagnosis of HAV Infection
Clinicians should suspect HAV infection in patients who have risk factors for hepatitis A and who have abrupt onset of prodromal symptoms (nausea, anorexia, fever, malaise, or abdominal pain), and jaundice or elevated serum aminotransferase levels. A complete serology panel with testing for hepatitis A (for acute HAV order IgM), B, and C is recommended in symptomatic patients. Because HAV IgM has a high false-positive rate, testing of asymptomatic individuals is not recommended. HIV testing is also recommended for those whose HIV-status is undocumented.
Providers testing patients in the outpatient setting should continue to use their standard laboratory testing procedures. LAC DPH Public Health Lab can facilitate testing of anti-HAV IgM for homeless persons presenting to emergency rooms/hospitals without in-house testing capability.

Hepatitis A Vaccination Resources
Medi-Cal: HAV vaccine is covered for patients enrolled in both fee-for-service and managed care plans. Vaccine administration is covered if administered in a provider’s office or by an in-network pharmacy. No prior authorization is required. Patients or those assisting them can call the plan’s member services number listed on the back of their Medi-Cal Benefits Identification Card to obtain information on pharmacy services. Prior to referring a patient to an in-network pharmacy for hepatitis A vaccination, please contact the pharmacy to verify vaccine availability.
AIDS Drug Assistance Program (ADAP): Hepatitis A vaccine is included on the ADAP formulary.
LAC DPH Clinics: Free hepatitis A vaccine is available at the LAC DPH Public Health Centers for any uninsured and underinsured at-risk people. Clinic times and locations are posted here.

For Questions:
Los Angeles County DPH Acute Communicable Disease Control Program
Weekdays 8:30am-5pm: call 213-240-7941
• After hours: call 213-974-1234 and ask for the physician on call.
Reporting for Residents of Long Beach and Pasadena
Long Beach Health and Human Services:
• Week days 8am-5pm: call 562-570-4302
• After hours: call 562-435-6711 and ask for Communicable Disease Officer.

Pasadena Public Health Department:
• Weekdays 8am-5pm: call the Communicable Disease Control Program 626-744-6089
• After hours: call 626-744-6043.

This Health Alert was sent by Dr. Sharon Balter, Director, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health.