hep·a·ti·tis  (hep’ă-tī’tis)

Inflammation of the liver, due usually to viral infection but sometimes to toxic agents.

[hepat- + -itis]

The Free Dictionary (Medical Dictionary)


Of the five different viruses responsible for causing infectious hepatitis (A – HAV, B – HBV, C – HCV, D – HDV {delta}, and E – HEV), hepatitis A may be the most common. It also causes the mildest of symptoms and doesn’t lead to chronic infections. HAV is highly contagious via the fecal-to-oral route (a person touches a person or a surface that has been contaminated with feces, or eats food or drinks water similarly contaminated). Symptoms of infection — if they occur at all — typically begin 2-6 weeks after ingesting the virus. Fever, fatigue, nausea, decreased appetite and weight loss, abdominal discomfort, and jaundice are most commonly reported in symptomatic individuals, but what is interesting is that a large number of people — mostly young children — exhibit no symptoms whatsoever. (70% of children under the age of six remain asymptomatic!) The virus causes liver inflammation for several weeks until it resolves completely, without any specific medical treatment, usually within two months in most cases. Complications — primarily fulminant hepatitis leading to liver failure — are quite rare with HAV infections, mostly affecting those with underlying liver disease.

Until the hepatitis A vaccine became available in the United States in 1995, HAV was one of the most frequently reported vaccine-preventable illnesses. Since then, rates have plummeted — from more than 35,000 reported cases in 1989 to 1,239 reported cases in 2014. Today, the two-dose hepatitis A vaccine is routinely given at the one-year well visit, and, again six months later, at 18-months of age. The vaccine is extremely effective in preventing infections, and immunity is life-long. Because children are the primary vectors of transmission to adults (because, you know, they are children!), they are the ones targeted for routine immunization, even though when symptomatic, they have the mildest symptoms and fewest complications.

There are certain groups of people who are at higher risk of symptomatic infections, complications, and even death — people with pre-existing liver disease, international travelers, personal contact with an international adoptee, personal contact or living in a household with a child who attends a child care center, a known food borne outbreak (Pittsburghers might remember the 2003 HAV outbreak that claimed the lives of four western Pennsylvanians and led to the demise of the Chi-Chi’s restaurant chain in the United States), illegal drug users, and men who have sex with men (MSM).

An additional group of people now needs to be added to those who are most vulnerable: the homeless. Last week, San Diego, CA county health officials declared a public health emergency after 421 cases of hepatitis A were reported since November 2016. Almost 300 people have been hospitalized and 16 have died. Alexa Lardieri says most patients have been between the ages of 5 and 87:

“The majority of people who have contracted hepatitis A are homeless and/or illicit drug users, although some cases have been neither,” the Health and Human Services Agency said.

To battle the outbreak, officials in the city of San Diego are planning to power-wash streets with bleach every other week. The bleach solution reportedly will be used predominantly on streets occupied by the homeless population.

Additionally, officials have installed dozens of hand-washing stations in San Diego County, and the Health and Human Services Agency is distributing hygiene kits that contain hand sanitizer, cleansing wipes, bottled water, an informational flyer and a waste bag.


Adults who are not vaccinated represent another at-risk group that Susan Scutti says are being targeted with public health interventions:

To combat the outbreak, public health officials have adopted a three-part strategy: vaccination; sanitation, which includes hygiene; and education.

Since June, the San Diego Police Department has been offering free hepatitis A shots through its homeless outreach and other programs.

“We’ve vaccinated over 21,000 individuals,” Wooten said. “The majority of those are the at-risk population or individuals who have association with the at-risk population.”


Colorado and Michigan have also been battling hepatitis A outbreaks this year, both of which are also unrelated to the consumption of contaminated food or water. It is clear that these victims are unvaccinated, which shouldn’t be surprising considering that the U.S. Department of Health & Human Services reports that less than 10% of American adults have been vaccinated against hepatitis A. Even if you don’t live within populations most vulnerable to this infection, you probably don’t live in a bubble, either. (And if you are reading this to the end, you probably have young children and grandchildren.) Talk to your doctor about getting the hepatitis A vaccine at your next checkup.


(CDC.gov/ havfaq)