Final update as of April 11, 2018.

With the slowdown in reported hepatitis A cases across California, CDPH has demobilized the outbreak response and continues to monitor reported hepatitis A cases statewide.  While CDPH might receive additional reports of outbreak-associated hepatitis A cases, CDPH has entered a new phase where monitoring of cases and prevention activities, such as vaccinating the at-risk population (people experiencing homelessness and/or using illicit drugs in settings of limited sanitation), have been shifted from emergency response to day-to-day operations. CDPH greatly appreciates the monumental efforts of federal, state, and local government partners, especially local public health departments and their community partners, as well as private partners, to control this large hepatitis A outbreak.  We encourage partners to continue providing hepatitis A vaccination for people experiencing homelessness, along with other high-risk groups, including people using illicit drugs and men who have sex with men.

Below is a summary of the outbreak and CDPH response as of April 11, 2018.  Any subsequent hepatitis A cases reported to CDPH will be included in our annual surveillance reports.

No future website updates of this page are planned.

The outbreak began in San Diego County in November 2016 and spread to Santa Cruz, Los Angeles, and Monterey counties.  To date, San Diego and Santa Cruz have reported the greatest number of cases, and in addition to cases in Los Angeles and Monterey counties, other counties have reported 17 outbreak-associated cases. The majority of people who have been infected with hepatitis A virus in this outbreak are people experiencing homelessness and/or using illicit drugs in settings of limited sanitation.  Other states are experiencing outbreaks in similar populations of at-risk people.  Following intensive efforts by local health departments and their clinical and community partners, including vaccination campaigns targeting the at-risk population, education, obtaining and managing vaccine, and many other interventions, the number of reported outbreak-associated cases has substantially decreased in California.

CDPH has helped to support the local health department response in the following ways:

  1. Coordinating and supporting hepatitis A outbreak response efforts across California and supporting the Governor’s declaration of a state of emergency to secure and purchase vaccine in a time of vaccine constraint.
  2. Monitoring the outbreak and providing epidemiologic support to the response by enhancing monitoring of cases, testing specimens to identify the outbreak strain, and providing staff and technical expertise, including developing and disseminating disease control, clinical, and vaccine prioritization guidance.
  3. Buying, distributing, and monitoring hepatitis A vaccine – to date, CDPH has distributed about 123,000 vaccine doses to local health departments during this outbreak.
  4. Communicating accurate information about the outbreak, control measures, and level of risk of hepatitis A infection for different populations with partners, the media, and the public.
​Jurisdiction ​Cases ​Hospitalizations ​Deaths
​San Diego ​587 402 20
​Santa Cruz 76 ​33 ​1
​Los Angeles ​12 8 ​0
​Monterey ​12 ​10 ​0
​Other 17 ​8 ​0
​Total 704 461 21

The Public Health Agency of Canada is collaborating with federal and provincial public health partners to investigate an outbreak of Hepatitis A infections in three provinces linked to the frozen fruit product: Nature’s Touch Organic Berry Cherry Blend. The Canadian Food Inspection Agency (CFIA) has issued a food recall warning advising Canadians of the recall of the frozen fruit product that has been distributed in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

The Public Health Agency of Canada advises Canadians not to consume the frozen fruit product Nature’s Touch Organic Berry Cherry Blend sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

The overall risk to Canadians is low. Hepatitis A is a disease that can cause inflammation of the liver. Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. You can get the Hepatitis A virus by eating contaminated food or water or through contact with an infected person’s stool. Adequate vaccination can protect against the Hepatitis A virus.

Currently, there are 12 cases of Hepatitis A in three provinces related to this outbreak: Ontario (9), Quebec (2), and Newfoundland and Labrador (1). Individuals became sick in February and March of this year. Some of the individuals who became ill have reported eating the recalled product. The majority of cases (58%) are male, with an average age of 37 years. Three cases have been hospitalized.

Inactivated-Hepatitis-a-Vaccine-Healive-PFS--300x198Shawn Flynn of KWC News reports that a Charlotte restaurant owner is going on the offensive battling perception and health concern over Hepatitis A.

“The restaurant industry is thriving,” said Jon Dressler, owner of three Charlotte-area restaurants.

That’s one reason he opened his third shop last Fall, Dogwood Southern Table in SouthPark.  Last month, however, he received a call no one wants to get. “We were contacted by the Mecklenburg Health Department that one of our employees had contacted Hep A while on vacation,” said Dressler. “It’s not a cleanliness issue, it’s not an internal issue. The health department didn’t have to shut us down.”

The Health Department issued an alert asking everyone who was there over a two day period to get a vaccination.  That created a lot of concern.  “It impacted the business slightly at first. We were deluged with phone calls,” said Dressler.

Dressler quickly became an expert on Hepatitis A and batted the reality versus perception of it. “To put it bluntly, you have a better chance of winning the lottery in Mecklenburg County than contracting Hep A. Transmission of Hep A has never happened in the history of Meck County,” said Dressler.

Rather than being upset, Dressler has another idea.  “It would be wonderful if all of Mecklenburg County restaurant workers were required to have the Hep vaccination,” said Dressler.

Lubbock City health officials Tuesday night warned anyone who ate at Cheddar’s Casual Cafe earlier this month they may have been exposed to hepatitis A after an employee there was diagnosed with the viral disease.

Diners who ate at the restaurant at 4009 S. Loop 289 from Aug. 31 through Sept. 8 may have been exposed, said Lubbock Health Director Bridget Faulkenberry.

The employee, who worked in food preparation, has not worked at the restaurant since Sept. 8, Faulkenberry said.

Meanwhile, the city is working to obtain vaccine to offer anyone who patronized the restaurant during that period. Information about immunization clinics will be announced when the vaccine is available.

Hepatitis A is a chronic infection of the liver that is caused by the Hepatitis A virus, also known as HAV. This virus is commonly transmitted through either the oral or the fecal route, by the contamination of food or drinking resources. The symptoms of hepatitis A may include fever, abdominal pain, excessive weight loss, diarrhea, depression, nausea, as well as jaundice.

Although there are no known drugs for the treatment of Hepatitis A, there are a number of preventive Hepatitis A drug treatments as well as vaccines that can be used as a precautionary method especially in developing countries where the incidence of Hepatitis A is quite high.

Some of the vaccines as well as the drug treatments for Hepatitis A include:

1. HAVRIX is a good drug treatment for Hepatitis A and is a vaccine that is used to help prevent Hepatitis A in adults. This vaccine works by exposing the body to a small and harmless amount of the virus to enhance the immunity of the body against Hepatitis A by increasing the production of antibodies against it. Vaccination with HAVRIX is essential for all adults travelling to areas or countries where the pathogenicity of the virus is high, including developing nations. It is also essential to be vaccinated by HAVRIX if the person is suffering from a liver disease, uses IV drugs, or receives any blood transfusion where the transmission of the virus is a threat. Working with laboratory animals may also put a person at risk of being exposed to the Hepatitis A virus.

2. VAQTA is also another vaccine used to treat Hepatitis A, which has the same mechanism as HAVRIX. This drug treatment of Hepatitis A can be administered to anyone who is older than 12 months and who is at a risk of infection by the virus. The vaccine may be injected in the muscles of the shoulder by a healthcare professional. A series of two injections can be administered over the course of six to 18 months. The dosage depends on the age of the person.

3. Another vaccine used for the treatment of Hepatitis A is TWINRIX, which is supplied as a sterile suspension that is administered intramuscularly. The vaccine is a combination of the Hepatitis A inactivated as well as Hepatitis B Recombinant vaccine and unlike VAQTA and HAVRIX, it can treat both Hepatitis A as well as B.

4. Dosages of Immune Globin or IG can also be given to people at risk of this disease. This vaccine is usually given intramuscularly into either the deltoid or gluteal muscles to children above the age of 12 months.

5. Other drug treatments for Hepatitis A that are highly effective are supportive treatments used to cure the accessory symptoms of the disease such as jaundice, depression, abdominal pains, etc.

The Rock Island High School in Illinois is the recipient of a $25,000 donation from food safety law firm Marler Clark. The Seattle-based law firm works nationwide on behalf of victims of foodborne illness, and assisted many residents in the 2009 outbreak of Hepatitis A Virus (HAV) traced to a Milan McDonald’s.

“Foodborne illness outbreaks can affect a great many people,” said Marler Clark managing partner Bill Marler. “With this donation, we want to encourage young minds to consider science, in the hopes that the next generation can improve food safety for all of us.”

 The Salt Lake Valley Health Department (SLVHD) has announced that a case of hepatitis A in a food worker employed at a local restaurant has been confirmed and they are urging some patrons to receive a preventive inoculation.

Health department officials say that people who ate at Quiznos at 30 East Broadway (300 South) in Salt Lake City on August 6 and 7 may be at risk for developing hepatitis A and should receive an injection of immune globulin (IG) or hepatitis A vaccine as soon as possible. These people can obtain a vaccination at the SLVHD City Clinic at 610 South 200 East today (August 19) until 5pm, tomorrow (August 20) from 8:30am to 6:30pm and Saturday (August 21) from 8:00am to 12 noon. The cost of vaccinations will be covered by Quiznos.

People who ate at the restaurant on these dates and who are not currently in the Salt Lake valley area are urged to contact their state or local public health department or their health care provider.

Additionally, people who ate at the restaurant between July 27th and August 5th may also have been exposed but would not benefit from the immunizations because immunizations must be given within 14 days of exposure. These people should watch for signs of hepatitis A and contact their health care provider if they develop illness.

Immune globulin and/or the hepatitis A vaccine can prevent infection if given within 14 days of exposure. People between ages 1 and 40 can receive hepatitis A vaccine; infants and people over 40 should receive immune globulin. If you have received the hepatitis A vaccine series, you do not need to be revaccinated.

Early signs of hepatitis A appear 2-6 weeks after exposure. Symptoms commonly include an abrupt onset of fever, loss of appetite, nausea, vomiting, diarrhea, tiredness, pain in the upper right side of the abdomen, dark urine and jaundice (yellowness of eyes or skin).

The disease varies in severity, with mild cases lasting two weeks or less and more severe cases lasting 4-6 weeks or longer. Some individuals, especially children, may not develop jaundice and may have an illness so mild it can go unnoticed. However, even mildly ill persons can be highly infectious. Persons with symptoms suggestive of hepatitis should consult a physician immediately, even if symptoms are mild.

Hepatitis A virus is spread as a result of fecal contamination (fecal-oral route) and may be spread from person to person through close personal or intimate contact or through food handling. The virus is commonly spread by contaminated food or beverages. Persons are at increased risk of acquiring hepatitis A when they have been in close and continuous contact with an infected person.

Quiznos Restaurant Inspection Information No other Quiznos restaurants have been affected by this Hep A exposure. SLVHD restaurant inspection records show that the Quiznos restaurant has had very good inspections in the past and the restaurant management is cooperating fully with the investigation. There are no other confirmed hepatitis A cases related to the restaurant at this time and the restaurant is still open for business. There is no risk of exposure at this time.

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States (Fiore, 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions; however, infection with the hepatitis A virus (HAV) can still lead to acute liver failure and death. Click on image to download: