CHA News Article

CDPH Advises Vaccination to Prevent Hepatitis A Outbreaks
Also recommends increased dosage for post-exposure prophylaxis

The California Department of Public Health (CDPH) has issued a clinical advisory about outbreaks of Hepatitis A in two California counties, recommending that providers show vigilance in offering the Hepatitis A vaccine to vulnerable patients. According to the advisory, 228 cases have been reported in San Diego County since November of last year, and 27 cases have been reported in Santa Cruz County in the last three months. CDPH states that transmission is presumed to occur person-to-person; no commercial product has been identified as being contaminated; and all populations who are homeless or using injection and noninjection illicit drugs can be considered at risk of outbreaks if exposed. The CDPH guidance contains detailed information on the vaccine, who should be encouraged to receive it and coverage provided by Medi-Cal plans.

CDPH has also updated its guidance on dosage of the vaccine, recommending that providers increase the immune globulin dosage when indicated for HAV post-exposure prophylaxis to 0.1 mL/kg, which is five times greater than the previously recommended dose. The dosages were changed based on reportedly lower concentrations of anti-HAV antibodies in the product due to decreasing prevalence of previous HAV infection among plasma donors.

The doses for pre-exposure prophylaxis for travel have also been increased to 0.1 mL/kg for stays up to one month, 0.2 mL/kg for stays up to two months and repeated boosters of 0.2 mL/kg every two months for stays beyond two months. See the attached announcement from the California Health Alert Network for more information about new recommended dosages.