Hepatitis A in the USA (California)

Media reports that hepatitis A virus continues to spread in California, with a new outbreak declared in Los Angeles. This outbreak remains small, involving 10 people, although a continuing outbreak in San Diego has involved nearly 450 people, of whom at least 16 have died. The San Diego outbreak has spread to Santa Cruz, where there are 69 cases.

At this stage, homeless people in California have been most affected as the virus is spread in poor sanitary conditions.

Advice to travellers

• Most travellers to California will be at low risk of hepatitis A.
• As with all other illnesses spread by the faecal oral route, precautionary measures should be taken to avoid consumption of potentially contaminated drinks and drinking water and to ensure food is uncontaminated or cooked thoroughly.
• Personal hygiene when eating and drinking is also important including hand washing prior to eating and using clean plates, cups and utensils.

When to consider vaccination

Vaccination should be considered under the following circumstances and is dependent on the individual risk assessment

• Non immune travellers to developing countries are at most risk of infection.
• Occasionally cases have occurred in travellers staying in good quality hotel accommodation but the risk is increased for:
• those travelling to areas where they will be exposed to unsafe drinking water
• where sanitation conditions are poor
• travellers visiting friends and family
• long stay travellers.
• Men who have sex with men (MSM)

For further information see Hepatitis A.