State Legislation Aimed at Preventing Hepatitis A Outbreaks Linked to Illicit Drug Use

January 31, 2019|4:56 p.m.| ASTHO Staff

Since 2017, several states have experienced hepatitis A outbreaks. Hepatitis A is a vaccine-preventable, communicable disease that can be spread through close personal contact with an infected person (e.g., via sexual intercourse, or sharing of personal items) or when a person eats food that is contaminated with the virus. In 2016, the last year with available data, there were an estimated 2,007 hepatitis A cases in the United States. However, even though the data for 2017 and 2018 cases are not yet available, CDC expects the incidence of hepatitis A to increase due ongoing outbreaks. The best way to prevent hepatitis A is through vaccination and good hygiene (i.e. thoroughly washing hands after using the bathroom and before preparing or eating food).

While past hepatitis A outbreaks were often linked to contaminated food (e.g., a 2016 outbreak linked to frozen strawberries), the current outbreaks are spreading among people who use drugs, people experiencing homelessness, and those who are in direct contact with them. The country’s continued opioid epidemic is also allowing hepatitis A to become more prevalent and causing those who use injection or non-injection drugs to be at an increased risk of infection. States have taken several legislative approaches to combat the spread of and mitigate the outbreak of infectious diseases, including hepatitis A. These approaches include increasing access to vaccinations as well as establishing methods for controlling the spread of infectious diseases. Below are examples recent state legislative activity in these areas.

Increasing hepatitis A vaccinations among adults in at-risk populations can help limit the size, duration, and spread of person-to-person outbreaks. For the current outbreak, vaccinating all food handlers would have little impact since it would not prevent or stop the spread of hepatitis A among the populations most at risk (e.g., individuals who use drugs or experience homelessness). Instead, increasing vaccine access to the at risk populations, either by increasing efforts to meet them where they are (e.g., at substance abuse centers, rehabilitation centers, emergency departments, correctional facilities, and homeless shelters) or expanding the scope of practice of healthcare providers who can administer the vaccine could be considered.

This year, New York’s legislature will consider bills (S2250 and A2900) authorizing pharmacists and certified nurse practitioners to provide hepatitis A immunizations. Currently, New York is the only state that does not authorize pharmacists to administer hepatitis A vaccinations. Forty-six states plus the District of Columbia and Puerto Rico permit pharmacists to give any vaccination approved by CDC’s Advisory Committee on Immunization Practices (ACIP) including hepatitis A. Three other states—Florida, West Virginia, and Wyoming—explicitly allow pharmacists to administer the hepatitis A vaccine.

Legislation allowing for the establishment of infectious disease prevention programs can also help mitigate health risks associated with drug use and the transmission of hepatitis A. To prevent the spread of infectious disease, these programs often provide sterile injection supplies and education. They may also encourage individuals who inject drugs to get regularly screenings and enroll in evidence-based treatment. In 2019, five states—Arizona (HB2148), Florida (SB366 and HB171), Maryland (SB0135 and HB0139), Montana (HB553), and New York (S498 and A60)—are considering bills to allow for the establishment of programs designed to prevent the spread of infectious diseases, including viral hepatitis. Under all bills, the programs would provide sterile injection supplies, collect used hypodermic needles and syringes, and secure safe hypodermic need and syringe disposal services. In addition, these programs would provide testing for viral hepatitis and other blood-borne diseases as well as education on the risks of contracting and transmitting viral hepatitis and other blood-borne diseases. Montana’s bill would require the department and human services to establish a pilot program.

As the current hepatitis A outbreaks continue, improving vaccination practices that serve impacted populations and establishing infectious disease prevention programs that address the underlying root of transmission are becoming more common policy approaches. State health agencies play an important role in advocating for and educating about effective vaccination legislation that may prevent or mitigate hepatitis A outbreaks. In addition, state health agencies are appropriate entities to help establish and regulate programs intended to prevent and eliminate infectious disease outbreaks through the provision of sterile injection supplies as well as education on the risks of contracting and transmitting hepatitis A. ASTHO will continue to track legislative activity on this important public health issue.

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