WHEREAS, Hepatitis A infection is a highly contagious liver disease caused by a virus that is transmitted by the fecal-oral route, either through personal contact or consumption of contaminated food or water, and is particularly hazardous for older individuals and those with underlying liver disease; and

WHEREAS, there are proven interventions to prevent and control transmission of Hepatitis A, including a safe and effective vaccine and improved sanitation; and

WHEREAS, a recent Hepatitis A epidemic in San Diego County, California occurred in 2017 and resulted in 592 reported infections and 20 deaths, primarily affecting people using illicit drugs and people experiencing homelessness, which was eventually controlled through increased vaccination and improved sanitation; and

WHEREAS, thus far in 2019, the Philadelphia Department of Public Health (the “Department”), Division of Disease Control, has confirmed 154 reports of acute Hepatitis A disease compared to an expected 3 reports as observed between January and July from 2013 to 2017; and

WHEREAS, the vast majority of the 2019 cases of Hepatitis A in Philadelphia have occurred since May (85%), where preliminary investigations indicate high proportions among adults who report using drugs (67%), or report experiencing homelessness (26%), provided that these risk factors are expected to increase as more investigations are completed; and

WHEREAS, increased reports of Hepatitis A are occurring in Southern New Jersey and Philadelphia’s suburban counties in Pennsylvania among at-risk populations, thus increasing the risk for more cases in Philadelphia; and

WHEREAS, since the summer of 2018, the Department has conducted extensive outreach to raise awareness and provide Hepatitis A vaccine and personal hygiene items to high-risk populations and potentially exposed persons living in neighborhoods with increased disease burden; and

WHEREAS, the Department has been working with Prevention Point Philadelphia, homeless shelters, hospital emergency departments, the Philadelphia Department of Prisons, and other city agencies who serve at-risk populations to expand outreach, promote vaccination, and increase the Department’s access to these high-risk groups, and has conducted street outreach to interact with these populations; and

WHEREAS, since the summer of 2018, there have been 12,439 reports of adult Hepatitis A vaccinations in the City of Philadelphia for all adults, the Department has administered 1,775 Hepatitis A vaccinations to at-risk people, and the Department has given out over 4,200 items to promote hygiene and education about Hepatitis A to at-risk populations, including hand sanitizer, soap, defecation bags, tissue packets, condoms, and educational pamphlets; and

WHEREAS, despite these aggressive and extensive efforts, Hepatitis A virus is spreading rapidly and is expected to continue doing so, thereby necessitating further action, stronger partnerships and cooperation, and expanded resources to control this epidemic; and

WHEREAS, the Philadelphia Department of Public Health is responsible for enforcing the City of Philadelphia Health Code, including Section 6-205 concerning emergency epidemic control;

NOW, THEREFORE, the Health Commissioner of the City of Philadelphia hereby declares the rapid increase of Hepatitis A infection incidence among at-risk groups a public health emergency, and instructs health care providers, managed care organizations and health insurers, and governmental and non-governmental organizations who treat or work with at-risk groups in Philadelphia to take the following actions to the extent applicable and feasible:

(1) Vaccinate people at risk, including: persons living homeless, people who use drugs, people who are or were recently incarcerated, men who have sex with men, and people with chronic liver disease with two-dose Hepatitis A vaccine, with the first dose administered at the first opportunity at hospital emergency departments, Federally Qualified Health Centers, primary care and ambulatory health centers, prisons and correctional facilities, and pharmacies; and

(2) Vaccinate close contacts of cases, including: sex partners, people who share living spaces, people who share drugs, and recent traveling companions who shared living spaces/bathrooms; and

(3) Reimburse for immunization services provided to health plan members related to this declaration; and

(4) Advise persons with Hepatitis A to take steps to prevent transmission, including hand washing, avoiding food preparation for others, condom use, and drug use harm reduction practices; and

(5) Promptly report acute cases of Hepatitis A by calling the Philadelphia Department of Public Health Division of Disease Control at 215-685-6740, or 215-686-4514 outside of business hours.

August 1, 2019

Thomas A. Farley, MD, MPH
Health Commissioner
City of Philadelphia