Hepatitis A rising among homeless, illicit drug users in Massachusetts, officials say

Hepatitis A is on the rise among homeless people and those who use illicit drugs in Massachusetts, state health officials said Tuesday.

The highly contagious virus and liver infection was discovered in six people last month in three counties surrounding Boston — Suffolk, Norfolk and Plymouth — as well as in Hampden County in western Massachusetts, they said.

No deaths were reported, but some patients were hospitalized, the state Public Health Department said in a statement. Four of the six patients are men 36 and older.

“Several individuals reported recent homelessness/unstable housing, injection drug use, and/or other drug use, and reported recently seeking services at Boston-area clinics, shelters and substance use treatment facilities,” the health department said.

In 2018, a hepatitis A outbreak in Massachusetts led to 563 cases and killed nine people, the department said.

“Populations at particular risk include individuals experiencing homelessness and persons who inject drugs,” it said.

A 2017 hepatitis A outbreak primarily among homeless people in San Diego triggered a nearly six-month health emergency. The county had recorded 20 deaths and 592 cases when the outbreak was declared finished in early 2018.

Homelessness that correlates to high housing costs has provided a target market for the persistent disease, which was blamed for the deaths of at least two people in San Diego this year.

County officials responded to the outbreak, in part, by partnering with the city of San Diego to install 66 hand-washing stations in public areas. Massachusetts health officials are encouraging the same response there.

Hand sanitizer “may not be effective” against hepatitis A, the health department’s statement said.

The outbreaks in both places were part of a national wave of hepatitis A that started in 2016 and continues in a few states, including Indiana, Maryland and Pennsylvania, according to the U.S. Centers for Disease Control and Prevention.

Other states declared the outbreak over, most by 2019, but not before the CDC had tallied 424 deaths nationwide. Massachusetts officials said its outbreak was finished in 2020; health officials consider the latest numbers part of a possible new wave.

The infection can thrive in unsanitary conditions.

Health officials also say men who have sex with men, people with chronic liver disease, heavy drinkers and global travelers can be at risk.

If the liver is inflamed, weakened or otherwise compromised, so is the body’s ability to fight infections and toxins, they noted.

Symptoms of fever, fatigue, loss of appetite, stomach pain, nausea, diarrhea and yellowing skin can appear two weeks to six months after exposure, and illness can last for weeks or even months, according to the CDC. Death is rare, but it does happen.

Vaccination, even within two weeks of exposure, can thwart the infection, experts say.

The state health department has this advice for local health leaders:

“Vaccinate all persons at high risk including persons experiencing homelessness or unstable housing, persons who inject drugs or use non-injection drugs or have chronic liver disease (including chronic hepatitis C infection or chronic hepatitis B infection), and men who have sex with men.”