Hepatitis A Cases With No History of Travel in Orange County
September 21, 2018
Orange County Public Health has received three reports in the last month of acute hepatitis A virus (HAV) illness in persons with no recent history of travel or exposure to a known case. All three cases are male, with an age range of 30 to 65 years and illness onset dates ranging from August 14 to September 15. The three have no identified common social contacts. None report a history of injection or noninjection drug use or homelessness; one has a history of having sex with men.  None report receiving hepatitis A vaccine in the past.

Last year’s hepatitis A outbreak in San Diego has subsided for several months, but outbreaks of HAV focused on persons with a history of homelessness and/or illicit drug use continue in other parts of the country. More information about San Diego’s outbreak can be found here .   15-26 cases of HAV infection were reported annually in Orange County from 2013-17 and eight cases have been reported so far this year. Infections in OC residents are generally occur after travel to an HAV-endemic area.
  • Providers should report any suspect or confirmed hepatitis A patients promptly to Orange County Public Health Epidemiology by phone at 714-834-8180 or by fax at 714-564-4050.
  • HAV infection should be considered in persons with signs and/or symptoms of hepatitis, particularly in those who report a history of homelessness, MSM and/or injection or noninjection drug use.
Symptoms and Transmission
  • HAV infection signs and symptoms include jaundice, dark urine, fever, malaise, anorexia, nausea, diarrhea, and abdominal discomfort, and increased transaminases (AST/ALT).
  • The incubation period for HAV infection ranges from 15–50 days. Most immunocompetent persons shed virus in the stool and are infectious from two weeks before through one week after the onset of jaundice.
  • HAV is generally transmitted through the fecal-oral route. Transmission occurs from close contact with a person infected with hepatitis A or exposure to feces-contaminated food, drinks, or other objects.
Laboratory Testing
  • All patients with confirmed HAV infection should have serum forwarded to Orange County Public Health Laboratory to arrange for genotypic testing. The California outbreak amongst homeless/drug users was caused by genotype 1B. Genotyping testing enhances public health surveillance and allows identification of cases related to other outbreaks.
  • HAV vaccination continues to be recommended for all children at one year of age, as well as persons with high risk conditions or behaviors including:
  • Persons with chronic liver disease, including those with hepatitis B or C virus (HBV or HCV) infection
  • Users of injection and noninjection drugs
  • Men who have sex with men
  • Persons traveling to or working in countries that have high or intermediate levels of HAV transmission
  • Persons who have been exposed to HAV in the prior 2 weeks and are not known to be immune
Contact Information
If you have any questions or concerns please contact the Epidemiology and Assessment Program at (714) 834-8180.
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