Philadelphia officials declare health emergency over hepatitis A outbreak

PHILADELPHIA – Philadelphia health officials have declared an emergency over an outbreak of hepatitis A in the city that has affected 154 people since January, and are calling for health providers to increase vaccinations to combat the liver disease.

Hepatitis A is caused by a virus that spreads through oral contact with infected feces – usually after a person has consumed contaminated food or water. Typically, the city sees about two to six cases a year.

But cases of the disease began to increase this year, and accelerated this spring, with more than 130 people contracting hepatitis A since May alone.

Most of the city’s hepatitis A cases this year – 67 percent – have occurred among people who use drugs, who are typically at high risk for the disease, the health department wrote in its emergency declaration. Of those cases, 26 percent occurred among people experiencing homelessness, another high-risk population. Other populations at risk include men who have sex with men and people currently or recently jailed.

Many cases occurred in Kensington, the epicenter of the city’s opioid epidemic, which has a high concentration of homeless people in addiction.

Silvana Mazzella, the associate executive director of Prevention Point, a Kensington-based public health organization for people in addiction, said that in the spring, staffers began to notice that more clients were falling ill. Symptoms of hepatitis A can include vomiting, jaundice and abdominal pain. While most cases resolve without treatment, the infection can be dangerous for seniors and those who are medically fragile or already have liver disease.

“The unfortunate thing is that when you’re unsheltered, and living outside or in encampments, people do get sick, and it spreads,” Mazzella said. “Any time you have people living communally and don’t have access to public bathrooms – essentially, places to defecate, or to wash hands – you’re going to get an increase in infection.”

Stephen Gluckman, medical director at Penn Global Medicine and an expert in infectious disease, said mass immunization is key to combating the outbreak.

“The solution is to immunize – and there’s an extremely effective vaccine that’s close to 100% effective,” he said. “The other solution is to try to improve the general hygiene in the area – by making sure there are enough clean places for people to defecate, and having access to things to clean your hands, something as simple as alcohol hand sanitizer.” By June, Mazzella said, the city was vaccinating hundreds of people in Kensington alone; many clients at Prevention Point were concerned about getting sick, and eager to get vaccinated, she said. The city is also installing public restrooms and handwashing stations in the neighborhood.

Tom Farley, the city health commissioner, said it’s not clear why the outbreak began this year when hundreds of people have been living rough in Kensington for some time.

In May, Pennsylvania declared a hepatitis A outbreak after identifying 171 cases around the state, with 40 of them in Philadelphia. (Other states around the country have dealt with much larger outbreaks; more than 2,000 cases have been reported in Ohio and West Virginia.)