Public health officials sound alarm following Hepatitis A outbreak among homeless, those who struggle with substance abuse

Massachusetts public health officials sounded the alarm Monday over an outbreak of hepatitis A among the homeless and those who struggle with addiction that has left at least one person dead.

There have been 65 reported cases of acute hepatitis A in the state since April, nearly half of them in Boston, said the state Department of Public Health. At least 68 percent of the cases have a co-infection of hepatitis C and at least 8 percent with HIV, according to the agency.

The state averages about 50 cases per year, state epidemiologist Dr. Catherine Brown said in an interview Monday evening, but more than 100 cases already have been reported this year.


Hepatitis A is highly contagious liver disease spread through oral-fecal contact or through contaminated food and water. Symptoms include fever, jaundice or yellowing of the eyes and skin, dark urine, pale stool, and diarrhea.

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No specific treatment exists for hepatitis A. In most cases, barring complications, the liver heals within six months with no lasting damage.

Brown said the illness is more commonly seen in people who traveled to countries “where the sanitation facilities are not as good as they generally are in Massachusetts.”

“Hepatitis A spreads in networks among people who have direct contact,” she said. “What we envision is that the virus was introduced at some point into the network, and transmission is being facilitated by lack of access to sanitary and hand-washing facilities.”

The at-risk population lives in “less than ideal circumstances,” Brown said, making it easier for them to come into contact with soiled clothing or contaminated surfaces and “compounding the transmission.”


Brown also stressed that not all of the people infected are injection drug users.

“This is really about individuals who are experiencing homelessness or unstable housing and/or have substance use disorder,” she said. “There is overlap, but it is not a one-to-one correlation.”

State authorities urged local health officials to work closely with community groups that provide services to the homeless and those with substance abuse issues, and make vaccines available to those most at risk.

The Centers for Disease Control and Prevention have been tracking hepatitis A outbreaks in similar populations in at least 10 other states, including California and Ohio, since 2017. Brown said the strain that officials are seeing in Massachusetts is not the one that is being found in other states.

The Boston Health Commission said Monday it is taking steps to prevent the spread of hepatitis A in the city. “BPHC is working with clinical and community partners to actively offer vaccinations and guidance for improving sanitation,” the agency said in a statement.


The commission stressed that the rise in cases in the city is “not linked to infected persons who have traveled outside of Boston or contaminated food or water” and urged vaccinations for at-risk populations.

The director of the commission’s Infectious Disease Bureau, Dr. Jenifer Jaeger, stressed that “vaccination and good hygiene, especially washing hands with soap & warm water, are the most effective ways to prevent the spread of hepatitis A.”

Matierial from the Associated Press was used in this report. Aimee Ortiz can be reached at Follow her on twitter @aimee_ortiz.