The following is an update from the Wisconsin Department of Health Services.

Important: Ongoing Hepatitis A Outbreaks

There are multiple ongoing hepatitis A outbreaks occurring in the U.S. These outbreaks began in 2017 and as of October 12, 2018, more than 7,000 outbreak associated cases have been reported from 12 states. The rates of hospitalizations (53-80%) and deaths (0-3%) during these outbreaks have been higher than what is normally reported through national surveillance of hepatitis A.

These outbreaks are primarily occurring in individuals who use drugs, people experiencing homelessness, and men who have sex with men. It is important that clinicians are aware of these high risk groups, as well as those listed below, and offer vaccine to protect these individuals.

Immunization, along with good hand hygiene, are the best ways to prevent hepatitis A infection. Please take the time to review health care professional and patient resources. Below are the immunization recommendations from Advisory Council on Immunization Practices (ACIP).

Childhood Immunization Recommendation

Routine vaccination:

  • 2 doses, separated by 6–18 months, between the 1st and 2nd birthdays. (A series begun before the 2nd birthday should be completed even if the child turns 2 before the 2nd dose is given.)

Catch-up vaccination:

  • Anyone 2 years of age or older may receive HepA vaccine if desired. Minimum interval between doses is 6 months.

Adult Immunization Recommendation

General information:

  • Administer to adults who have a specific risk (see below), or lack a risk factor but want protection, 2-dose series of single antigen hepatitis A vaccine (HepA; Havrix at 0 and 6–12 months or Vaqta at 0 and 6–18 months; minimum interval: 6 months) or a 3-dose series of combined hepatitis A and hepatitis B vaccine (HepA-HepB) at 0, 1, and 6 months; minimum intervals: 4 weeks between first and second doses, 5 months between second and third doses

Special populations

Note: It is anticipated that in February 2019, the ACIP guidance will be published with includes individuals experiencing homelessness as a high risk group.

  • Administer HepA or HepA-HepB to adults with the following indications:
    • Men who have sex with men
    • Injection or noninjection drug use
    • Clotting factor disorders
    • Chronic liver disease
    • Travel to or work in countries with high or intermediate hepatitis A endemicity
    • Work with hepatitis A virus in a research laboratory or with nonhuman primates infected with hepatitis A virus
    • Close, personal contact with an international adoptee (e.g., household or regular babysitting) during the first 60 days after arrival in the United States from a country with high or intermediate endemicity (administer the first dose as soon as the adoption is planned)
    • Healthy adults through age 40 years who have recently been exposed to hepatitis A virus; adults older than age 40 years may receive HepA if hepatitis A immunoglobulin cannot be obtained

Wisconsin Immunization Coalitions

The Immunization Program is working on a project to identify and coordinate with immunization coalitions at the local or regional level. If you are aware of any active coalitions that are missing fromthe program website, or are interested in coordinating with us please contact elise.balzer@dhs.wisconsin.gov.

Looking for more information about what a coalition is? Please visit the Immunization Action Coalition website.

Immunization Education and Resources

New Continuing Medical Education (CME) Opportunity: ”Making the Case, Championing for HPV Cancer Prevention in Your Practice.” This new CME is designed to educate clinicians about current HPV vaccine recommendations, best practices for effectively recommending HPV vaccination and addressing questions form parents of age-appropriate boys and girls, and strategies to foster team wide collaboration. This is available on demand and can be accessed here.

Updated Pertussis Report

An updated pertussis report can be found on the Immunization Program website under Vaccine Preventable Diseases. This report summarizes pertussis case occurrence and investigation activity in Wisconsin from January 1, 2018 to November 30, 2018.