Hepatitis A

April 25, 2019

Dear Colleague:

Between January 1, 2019 and April 19, 2019, Virginia has reported 44 cases of hepatitis A (HAV), a 132% increase compared to the same time period in 2018. The Centers for Disease Control and Prevention (CDC) recently updated a Health Alert Network (HAN) Advisory indicating that multiple states across the country have experienced HAV outbreaks, primarily among people who use drugs and people experiencing homelessness. Since these outbreaks were first identified in 2016, more than 15,000 cases and 8,500 hospitalizations (57% of cases) have been reported in the United States.  In Virginia, the increase in HAV cases indicates that the Commonwealth is now experiencing the effects of this nationwide outbreak, and action is needed to prevent the continued spread of hepatitis A.

Virginia’s local health districts are working with community partners to increase vaccination efforts, with specific focus on persons at high risk of acquiring HAV infection or developing serious complications from infection. CDC has reported that one dose of single-antigen hepatitis A vaccine has been shown to control HAV outbreaks.

To help control the spread of hepatitis A, please consider taking the following actions:

  1.  Assess your patients’ hepatitis A vaccination status. Offer vaccine to those not adequately immunized, including the following high risk groups:
    • People who use drugs (injection or non-injection)
    • People experiencing homelessness
    • Men who have sex with men (MSM)
    • People who are, or were recently, incarcerated
    • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
  2.  If you do not stock the hepatitis A vaccine, refer your patients to a local pharmacy or local health department.
  3.  Enter vaccine administered in Virginia Immunization Information System (VIIS), the statewide immunization registry.
  4.  Immediately report cases of HAVto your local health department, preferably by telephone. This ensures that timely public health prevention and control steps can be initiated, including post-exposure prophylaxis (hepatitis A vaccine or IG) for individuals with direct, recent (within 2 weeks) contact with a case.

We have established an HAV webpage on the Virginia Department of Health website with resources for you and your patients. If you have any additional questions, please contact the Division of Immunization at 804-864-8055 or your local health department. Thank you for your partnership in preventing the spread of HAV in Virginia.


M. Norman Oliver, MD, MA
State Health Commissioner