Separate outbreaks of hepatitis A (hep A) and hepatitis B (hep B) occurring in the Spokane community prompted rapid response from Spokane Regional Health District (SRHD) to administer Twinrix (hepatitis A and B combination vaccine) to the communities at highest risk for disease acquisition, namely people living homeless, people using injection drugs, and men who have sex with men.

Upon identification of an increase in cases of acute hep B infection in 2018 with injection drug use and high-risk sexual activity as the primary risk activities, SRHD began administering vaccine in the syringe services program in the Health District building as well as at meal sites and service providers for people living homeless. Through spring 2019, nearly 700 doses of Twinrix were given.

In late May 2019, several cases of acute hep A infection were reported to SRHD. Like most of the other large-scale hep A outbreaks occurring in the country, all cases have reported a history of living homeless and substance abuse. Immediately, SRHD worked with shelters and other providers of services to those living homeless to offer on-site Twinrix vaccination services to clients and staff. To date, an additional 400 doses of Twinrix have been provided to this high need population.

Twinrix vaccination is highly protective against hep A after one dose; however, for the hep B component, three doses are necessary to achieve optimal protection. SRHD is using a variety of strategies, including reminder/recall texts and subsequent shelter vaccination efforts, to ensure multiple dose coverage.

While reported cases of acute hep B infection have slowed and returned to baseline, SRHD epidemiologists would like to remind healthcare providers of acute hep B’s long incubation period (up to six months) and to remain vigilant for possible cases with symptoms consistent with hep B in risk populations. Vaccine should be offered to all infants and children not previously vaccinated, as well as adults with risk factors.

For clinical information, learn more here: Increase in Acute Hepatitis B Cases.

New cases of acute hep A infection continue to be reported. Consider hep A infection as a diagnosis in anyone with jaundice and clinically compatible symptoms including fatigue, fever, headache, joint pain, nausea, vomiting, abdominal pain, loss of appetite, dark urine, and clay colored stools. Vaccine should be offered to all children at age 1 year and to people with unstable housing or experiencing homelessness, at increased risk for infection, at increased risk for complications from hep A, and wishing to obtain immunity.

For clinical information, learn more here: Outbreak of Hepatitis A Infections Among Persons Who Use Drugs and Persons Experiencing Homelessness.