February 16, 2018

woman getting vaccinated

In 2017, hepatitis A outbreaks have struck San Diego County, Detroit, Michigan and other areas around the U.S. Many of the people who have become ill are experiencing homelessness. San Diego has declared a local public health emergency due to the outbreak.

Currently, there is no outbreak of hepatitis A in the Portland region. Because California is our neighbor, we have been monitoring these outbreaks closely. Health officials track all hepatitis cases and are taking steps to prevent a similar outbreak.

If your organization serves homeless clients, you can help by:

  • Advising sick clients to seek care
  • Encouraging clients to get the hepatitis A vaccine
  • Encouraging good hand washing
  • Stocking washrooms with soap and paper towels

About Hepatitis A

Hepatitis A is a virus that can cause liver disease that lasts a few weeks to a few months. It causes belly pain, body aches, nausea and lack of appetite, followed by a yellowing of the skin. 

Children tend to have mild symptoms. Most adults will feel sick if they get hepatitis A, and most will recover completely. A few will have serious liver problems, which can be fatal.

How It Spreads

Hepatitis A spreads very easily. When someone is sick with hepatitis A, the virus is released in their poop. They can spread the virus even before they start to feel sick.

The virus is usually spread by:

  • Touching objects or eating food that was handled by someone with hepatitis A.
  • Having sex with someone who has a hepatitis A infection.

Those in close contact with an infected person are the most likely to get sick.

How to Avoid It

Hepatitis A can be prevented by:

  • Getting the hepatitis A vaccine. Even just one shot gives a lot of protection.
  • Washing hands often with warm soap and water, especially before eating or preparing food, and after using the toilet or changing diapers.

Local health officials recommend the hepatitis A vaccine for any homeless person who has not already received it. It’s also recommended for any adult who:

  • Has chronic liver disease
  • Uses drugs
  • Is a man who has sex with other men
  • Plans to travel to a country where hepatitis A is common
  • Wants to be protected

You can get vaccinated at your primary care provider or local pharmacy.

The vaccine requires 2 or 3 doses (depending on which kind you get) spaced several months apart. Almost everyone is protected after just one dose of any vaccine that includes hepatitis A.

The hepatitis A vaccine has been required for school children in Oregon since 1995. Many adults may not have been vaccinated.

If You Work with Homeless People

Almost one third of hepatitis A cases in San Diego County were in health care providers, social service providers and outreach workers who work closely with people who were homeless or using drugs.

Employers should decide whether to offer, recommend or require the hepatitis a vaccine for on-the-job safety. If you’re interested in getting vaccinated, you should strongly consider getting the Twinrix vaccine, which protects against both hepatitis A and B.

Cleaning Soiled Items

Bedding and Clothing Wash with soap and a cup of bleach. Dry clean items that cannot be washed with bleach. Discard any items that can’t be washed with bleach or dry cleaned.

Wear disposable gloves during clean up, and wash your hands with warm soap and water afterwards.

Hard Surfaces Disinfect using a bleach solution of 5000 ppm. To prepare a 1:10 household bleach solution (using 5.25% bleach), combine:

  • 62 ml (1/4 cup) household bleach + 562 ml ( 2-1/4 cups) water
  • 250 ml (1 cup) household bleach + 2250 ml (9 cups) water

If using hospital-grade disinfectant, make sure it lists effectiveness against hepatitis A and use exactly as directed. List of EPA approved cleaners


Frequently Asked Questions

Do hand sanitizers work against hepatitis A?

No. Washing with soap and warm water is the only effective way to remove the virus from your hands.

How are you making sure that people who are experiencing homelessness get multiple doses of vaccine?

Most people are protected after just one dose. Providers and pharmacists should tell people that they need to return for the second shot to be fully protected. For the most common adult vaccine, the second shot is due after 6 months. The priority is to get the first dose to those who need it most.

Will you expand bathroom and hand washing access in the event of an outbreak?

Public health officials are working closely with city representatives to find ways to increase access to public bathrooms and hand washing facilities in the event of an outbreak.

Isn’t there a shortage of hepatitis A vaccine?

This year’s outbreak has increased demand for the adult vaccine, leading to decreased supply. The children’s vaccine has not been affected. The Oregon Public Health Division's Immunization Program is working closely with the Centers for Disease Control and Prevention and counties to maintain our supply.

Those in close contact with an infected person are the highest priority for getting a protective vaccine, regardless of their ability to pay.

More Information