Status:
Active
Health advisory:
201516
Date Issued:
22 May 2020
Issued by:
Dr Angie Bone, Deputy Chief Health Officer (Environment)
Issued to:
Health professionals, drug and alcohol and homelessness service providers

Key messages

  • There has been an outbreak of hepatitis A among people who use drugs (primarily but not exclusively by injection), as well as people experiencing homelessness in Victoria. As of 6 May 2020, there have been 56 confirmed cases and 6 possible cases of hepatitis A associated with this outbreak since July 2019.
  • A free single-dose hepatitis A vaccination is available for people who use drugs or are experiencing homelessness until 31 August 2020.
  • Vaccination is available at GP clinics providing specialised services to people who use drugs and people experiencing homelessness as well as via a mobile outreach service.
  • Consider hepatitis A infection in patients presenting with a compatible illness in these risk groups and take blood for serology (IgM).
  • Notify all suspected cases of acute viral hepatitis without waiting for serology results to the Department by calling 1300 651 160.

What is the issue?

There is an ongoing hepatitis A outbreak in Victoria affecting predominantly people who use drugs, as well as people experiencing homelessness. As of 6 May 2020, there have been 56 confirmed cases and 6 possible cases of hepatitis A associated with the outbreak since July 2019.

To control the outbreak in Victoria, a hepatitis A vaccination program targeting people who use drugs as well as people experiencing homelessness is available until 31 August 2020.

As both hepatitis B and hepatitis C are highly prevalent among people who inject drugs, hepatitis B vaccine should also be offered and screening for both conditions considered. People who positive for hepatitis B, C should be encouraged to commence treatment.

Influenza vaccine should also be provided to those eligible under the National Immunisation Program.

Who is at risk?

Most people are susceptible to hepatitis A infection, unless they have had the infection following exposure in an endemic country, or they have received a full course of hepatitis A vaccine.

In the current outbreak, people who use drugs and/or people who are experiencing homelessness (especially people sleeping rough) appear to be at highest risk, however local transmission among people without these risk factors have also occurred.

Symptoms and transmission

The incubation period for hepatitis A infection is between 15 to 50 days with an average of 28 days.

Transmission is through the faecal-oral route and can occur when traces of virus are ingested, usually via contaminated hands, objects, water or food. Transmission can also occur through oral-anal sexual activity. People are infectious two weeks prior to symptom onset until around one week after the onset of jaundice or dark urine. This means people may transmit the infection to others for an extended period even before becoming unwell.

Initial symptoms typically include fever, malaise, anorexia, nausea, vomiting and abdominal discomfort, followed a few days later by dark urine and jaundice. Initial symptoms may mimic influenza, so hepatitis A should be considered in the differential diagnosis for patients presenting with an influenza-like illness who have recent overseas travel to a high-risk country and/or other risk factors. 

Symptoms usually last several weeks although convalescence may sometimes be prolonged. People with pre-existing liver disease may have poorer outcomes if infected with hepatitis A virus. Death from hepatitis A is uncommon and is estimated to occur in up to two per cent of infected adults.

Young children under five years of age infected with hepatitis A virus may have a mild illness with few or no symptoms but can still transmit infection to others.

Recommendations

  • All adults who use drugs (especially people who inject drugs) or are experiencing homelessness are strongly encouraged to get a free single-dose hepatitis A vaccination from their GP clinic that provides specialised services to people who use drugs and people experiencing homelessness or from the mobile outreach service.
  • Advise people who use drugs not to share or re-use consumption equipment. For people who inject drugs this included needles, spoons, swabs, water, or any other injecting equipment. Sterile injecting equipment is available for free across Victoria.
  • Advise people who use drugs to wash their hands in warm soapy water before and after injecting and swab the injection site with alcohol swabs. Special care should be taken when injecting in groups, or when being injected by others. People should label or mark their syringe.

    Suspected cases:

  • Patients suspected to have hepatitis A should not prepare food or drink or share utensils, provide personal care for others, share linen or towels, have sex or donate blood until infection is excluded. 
  • If your patient presents with symptoms compatible with hepatitis, include a request for serology (IgM) for hepatitis A, in addition to usual tests. 
  • If you suspect acute viral hepatitis, notify immediately by calling 1300 651 160. This will assist with patient assessment, consideration of public health control measures and will enable rapid post-exposure prophylaxis for close contacts.

    Confirmed cases:

  • If hepatitis A is confirmed, your patient should not prepare food or drink or share utensils, nor provide personal care for others, share linen or towels and should avoid any sexual activity while potentially infectious.
  • People who have had confirmed hepatitis A are not eligible to donate blood for 12 months after their infection. 
  • People who have been exposed to a confirmed case of hepatitis A are not eligible to donate blood for two months after their exposure, as a precaution. 

More information

For more information call 1300 651 160.

Information for clinicians and service providers

Hepatitis A vaccination program - information for clinicians

Hepatitis A vaccination program- information for drug and alcohol and homelessness accommodation service providers

Important health information to people who inject drugs: a guide for health professionals and immunisation providers – free state-wide Hepatitis B vaccination program

Consumer information

Please contact 1800 703 003 for an up-to-date list of service providers.

Hepatitis A vaccination program- information for consumers

Hepatitis A (Better Health Channel)

Needle and syringe program