By Sandee LaMotte, CNN
(CNN) - The battle against
Hepatitis A
outbreaks across the US is being stymied by a national shortage of the vaccine
needed to combat it.
"Current supply is not sufficient to support demand for
vaccine," the US Centers for Disease Control and Prevention told CNN in a
written statement.
Southeast Michigan has seen 495 cases of Hepatitis A and 19
deaths, mostly in Macomb and Wayne counties and in Detroit. The outbreak began
in August of 2016, and after a drop off during the winter, has been climbing
since February of this year, said Michigan Department of Health and Human
Services spokesperson Angela Minicuci.
"We have a limited supply of vaccine," said
Minicuci, "so we are prioritizing delivery to high-risk populations."
In California an outbreak of the virus has sickened at least
644 people and claimed 21 lives, mostly in the cities of San Diego, Santa Cruz,
and Los Angeles, according to the
CDC.
Persons infected with the virus there have also spread it to
Arizona, Utah, and Colorado, said Dr. Wilma Wooten, Public Health Director at
San Diego's Health and Human Services Agency.
To manage the current shortage, the CDC said, staff have
been working closely with public health officials to target vaccinations toward
at-risk populations, as well as coordinating with vaccine manufacturers
"to monitor and manage public and private vaccine orders to make the best
use of supplies... during this period of unexpected increased demand."
An unexpected demand
"It's unprecedented what we are seeing out of
California and other parts of the country," said GlaxoSmithKline
spokesperson Robin Gaitens. "The shortage is simply an issue of supply and
demand."
Outbreaks of Hepatitis A are normally small, because the
vast majority of the US population was inoculated as children at approximately
one year of age. GlaxoSmithKline and Merck are the only companies approved by
the Food and Drug Administration to sell a Hepatitis A adult or pediatric
vaccine in the US.
"We typically provide 1.2 million adult doses each year
to the US market, and the demand this year has vastly surpassed the supply on hand,"
Gaitens said. She stressed there is no shortage of the pediatric version, which
is given in a two-dose series about six months apart. Nor is there a shortage
of their combination hepatitis A/B vaccine.
The current outbreaks of hepatitis A, virus genotype (IB),
is normally not found in the US; it's more common to the Mediterranean, Turkey
and South Africa. However, the current vaccine is effective against all strains
of the virus.
In an emailed statement, Merck said it has been taking steps
to increase the manufacturing capacity of both their adult and pediatric
versions of their vaccine due to "unexpected demand in markets."
"At the end of October, we began shipping single-dose
vials (in packages of 10 vials) for adults, which previously had been on
backorder," the statement said. "We anticipate the availability of
adult and pediatric pre-filled syringes of the vaccine in the first quarter of
2018."
GlaxoSmithKline also began shipping backordered single-dose
syringes at the end of October, Gaitens said, adding that the company is
working closely with the CDC and California officials on "how to
distribute and to ensure the vaccines are actually going to where there is the
greatest need."
What is hepatitis A?
Hepatitis A is a highly contagious liver disease caused by
the HAV virus. The virus is found in the feces of people with the disease, and
is most frequently transmitted by eating food or drinking water handled by
someone who has not properly washed their hands. It's also transmitted by sex
and by illicit drug use.
Some of the most common symptoms include nausea, vomiting,
fever, fatigue, loss of appetite and jaundice, or yellowing of the skin or
eyes. It can take 15 to 50 days to show symptoms of the infection; however, an
infected person is most contagious during the two weeks before their skin turns
yellow.
According to the CDC, the hepatitis A virus is very hard to
kill and can live for months outside the body. Hand sanitizers are not
effective against the virus, so frequent hand washing is critical to
controlling any outbreak.
A growing threat
California is in the middle of the biggest person-to-person
outbreak of hepatitis A since the vaccine first became available in the
mid-90s, according to the California Department of Public Health.
San Diego has been hardest hit, with 546 confirmed cases and
20 deaths as of November 14, the latest numbers released by the County of San
Diego Health and Human Services Agency.
Cases were first seen in November 2016 and in March
officials determined they were dealing with an outbreak. It has spread
predominantly among the homeless and drug users in the city, said agency
spokesperson Craig Sturak. Homelessness is a year-round problem for San Diego,
he added, and accompanying issues of sanitation helped fuel the spread.
"We've focused on a couple of different
strategies," said Sturak. "A large vaccination effort---we've
vaccinated over 100,000 people -- and the city is doing a big clean up by
power-washing streets and cleaning up trash in areas where the homeless are
congregating."
Despite the current shortage, Public Health Director Wooten
said her agency has had enough vaccine on hand to deliver a first dose to most
of the estimated 150,000 at-risk population in the San Diego area.
"With an outbreak you want to get those first doses
into the arms of as many people as possible as fast as possible," said
Wooten "At that point they will be 90% to 95% protected. It's the second
dose that takes you up to 100% protection."
Wooten said the county had planned to start a campaign soon
to administer the second dose, but delayed the program until spring due to the
shortage. But she stressed that nurses out in the at-risk community are
administering the additional dose if they come across anyone who requires it.
"We're also targeting those who fall under the CDC
guidelines, such as the MSM, or men having sex with men population, or anyone
who currently has hepatitis B or C," said Wooten. "We have access to
15,000 doses for the month of November to meet that need, and if we need
additional doses in December we will ask the state for those as well."
California's outbreak led Governor Jerry Brown to declare a
state of emergency in mid-October. The declaration allowed the state to
"immediately purchase additional vaccines directly from manufacturers and
coordinate distribution to people at greatest risk in affected areas."
