Health Care Provider Information
Hepatitis A Public Health Emergency
August 2019

Florida, like other parts of the United States, is experiencing a serious hepatitis A virus (HAV) outbreak. Since 2018, there have been more than 22,000 cases of HAV in the United States. In Florida, there have been more than 2500 cases since 2019 and more than 2,000 cases since January 2019. This outbreak has come at a personal cost to our residents, as 78% of individuals with HAV have been hospitalized and 31 individuals have died. In response, on August 1, 2019, with the support of Governor Ron DeSantis and Lieutenant Governor Jeanette Nuñez, Florida’s State Surgeon General declared a Public Health Emergency.

The key to controlling this outbreak is vaccinating individuals at highest risk for contracting HAV, which includes persons who use intravenous or non-intravenous drugs and the homeless population. In addition, individuals who are at risk for serious outcomes need to be vaccinated. The HAV vaccines are inactivated viruses and have an excellent safety profile. Two doses separated by six months are recommended; however, one dose is 93% effective. Information about HAV from the CDC is available HERE. Information specific to the Department of Health’s response and vaccination sites can be found HERE.

As a health care provider, please consider the following:

1. If you are caring for individuals in the inpatient, outpatient, or emergency setting with intravenous or non-intravenous illicit drug use, who are homeless, or who are currently incarcerated, vaccinate them.
2. If an individual is treated in an emergency room or other acute care setting after being administered an opioid antagonist, such as naloxone, vaccinate them prior to discharge
3. Identify your patients with underlying liver disease and offer the HAV vaccine. If such individuals are hospitalized, consider vaccinating them prior to discharge.
4. Individuals over 60-years-of-age with complex medical conditions, such as diabetes mellitus and cardiovascular disease, are at risk for serious complications or even death if they contract HAV. If you are in a critically impacted county as defined in the declaration, identify patients with serious medical conditions and offer the HAV vaccine. If such individuals are hospitalized, consider vaccinating them before discharge.
5. Vaccinate men who have sex with men.
6. Vaccinate individuals who work with persons with a history of drug abuse or homelessness in a non-health care setting.
7. Hepatitis may present with non-specific flu-like and/or gastrointestinal symptoms. Health care providers are encouraged to screen for hepatitis A in patients with such symptoms by ordering liver function tests and transaminase levels (ALT/SGPT, AST/SGOT), in addition to hepatitis A serology. These tests should also be considered for individuals who present with jaundice, light-colored stools, or dark-colored urine.
8. As always, use standard precautions when interacting with patients. Handwashing with soap and water by health care providers after contact with HAV-positive patients or high-risk populations is essential. Commonly used alcohol-based hand sanitizing products are NOT effective against HAV.
9. All surfaces in restrooms and bathing areas should be disinfected at least once per day at your facilities. A standard ready-to-use 1 to 10 bleach solution applied to a surface for one minute is effective in destroying the virus on surfaces.
10. Notify your county health department immediately when HAV infection is confirmed in your patients.
11. Please contact the Department of Health at HepA@FLHealth.gov with questions and concerns.

Thank you for your commitment to public health in Florida.