Massachusetts health officials are warning that a handful of hepatitis A infections last month are similar to an outbreak that began five years ago and ultimately claimed nine lives.
Six cases were reported between Nov. 1 and Nov. 29 in Suffolk, Norfolk, Hampden and Plymouth counties, including among four men between the ages of 36 and 60, according to a clinical advisory from the state Department of Public Health. More potential cases are being reviewed, officials said.
DPH described hepatitis A as a "highly contagious liver infection" that can be mild and last for a few weeks, or severe and last several months.
Four people were hospitalized for their infections, which DPH said are "primarily spread person-to-person through the fecal-oral transmission route and contact with a fecal-contaminated environment."
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Some of the infected individuals had recently experienced homelessness or housing instability, as well as sought care for substance use treatment at Boston-area facilities. None of the cases involved travel history outside of Massachusetts, officials said.
The hepatitis A cases echo an outbreak in Massachusetts from 2018 to 2020 that saw 563 cases, DPH said. Other "infection clusters" were recorded at the time in California, Indiana, Kentucky, Michigan, Tennessee, Utah and West Virginia.
"Given the pattern of significant HAV outbreaks previously seen involving similar populations, here and in other jurisdictions, there is concern that additional hepatitis A transmission and morbidity will likely occur in the Commonwealth," DPH said. "Effective prevention and response measures include early identification of cases, vaccination, enhanced sanitation processes, and education of populations who may be at risk."
Nearly 20 hepatitis A cases were confirmed in Portland, Maine in mid-November, as officials and advocates reported outbreaks in homeless encampments, according to the Portland Press Herald.
DPH recommends that health care providers stay vigilant for hepatitis A symptoms -- including fever, fatigue, loss of appetite, stomach pain and jaundice -- among patients, particularly those who are homeless or inject or use drugs. Community health workers and mobile vans caring for unsheltered individuals should also provide vaccines, DPH recommended.
