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2017 – Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs


Since March 2017, CDCs Division of Viral Hepatitis (DVH) has been assisting several state and local health departments with hepatitis A outbreaks, spread through person to person contact, that have occurred primarily among persons who are homeless, persons who use injection and non-injection drugs, and their close direct contacts.

States Outbreaks

Information on local hepatitis A case counts and outbreak response is available on web pages for the locations that have been affected by or are currently experiencing an outbreak (California, IndianaKentuckyMichigan, Utah).

CDC’s Response:

In response to these and all hepatitis A outbreaks, CDC provides ongoing epidemiology and laboratory support as well as support on vaccine supply and vaccine policy development. When requested, CDC sends “disease detectives” to affected areas to evaluate and assist in the outbreak response.

CDC alerts other public health jurisdictions of any increases in disease. On August 25, 2017, CDC notified all state and local health departments about the investigation of a cluster of hepatitis A, genotype IB infections in people who are homeless and/or use injection and non-injection drugs. All U.S. jurisdictions were encouraged to be watchful for increases in hepatitis A cases and consider submitting recently confirmed hepatitis A virus (HAV) specimens to CDC’s Division of Viral Hepatitis Laboratory. CDC’s Division of Viral Hepatitis Laboratory uses advanced molecular detection to confirm and monitor outbreaks and has tested over 1,000 specimens related to various outbreaks this year. CDC also works with state and local health officials to ensure hepatitis A vaccine is targeted to the correct at-risk populations and that supply is adequate.

Advice to Public Health Officials

For the current U.S. outbreaks among people who are homeless and/or people who use injection and non-injection drugs, CDC has encouraged state and local health departments to:

  • Work with community partners to provide hepatitis A vaccine to people who are homeless, people who use injection and non-injection drugs, and others with established risk factors who are not yet immunized
  • Consider hepatitis A vaccination for anyone with ongoing, close contact with people who are homeless or people who use injection and non-injection drugs


CDC has provided interim outbreak-specific guidance on hepatitis A vaccine administration.

Post exposure prophylaxis (PEP) is recommended for unvaccinated people who have been exposed to hepatitis A virus (HAV) in the last 2 weeks; those with evidence of previous vaccination do not require PEP.

PEP consists of:


NOTE: CDC recommends that all children be vaccinated against hepatitis A at age 1 year. Parents or caregivers who are unsure if a child has been vaccinated should consult the child’s health-care provider to confirm vaccination status.


If you think you are infected with hepatitis A, contact your health-care provider.

  • Some symptoms of hepatitis A virus infection include:
    • Yellow eyes or skin
    • Abdominal pain
    • Pale stools
    • Dark urine

Hepatitis A Vaccination Recommendations

CDC recommends the following groups be vaccinated for hepatitis A:

  • All children at age 1 year
  • Travelers to countries that have high rates of hepatitis A
  • Family members and caregivers of recent adoptees from countries where hepatitis A is common
  • Men who have sexual contact with other men
  • People who use injection and non-injection illegal drugs
  • People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
  • People who are treated with clotting-factor concentrates
  • People who work with hepatitis A infected animals or in a hepatitis A research laboratory