Public Health Dispatch: Multistate Outbreak of Hepatitis A Among Young Adult Concert Attendees --- United States, 2003

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In July 2003, a cluster of hepatitis A cases was identified among young adults who had attended outdoor concert and camping events featuring various "jam bands." As of September 2, a total of 25 cases have been reported among residents of nine states (Arizona, California, Colorado, Indiana, Michigan, New York, Oregon, Tennessee, and Wisconsin). The majority of cases were among young adults who attended concerts during the spring and summer. The median age of infected persons was 23 years (range: 17--44 years); 14 (56%) were male.

The bands performing at these concerts and festivals attract fans who travel from one concert to another, sometimes continuously over several months. Concerts often are multiday events involving camping on established or impromptu campgrounds, and sanitary conditions sometimes are poor. Unofficial food vendors are common at these events, and many are concert attendees. Attendance at the events has ranged from 1,200 to 82,000 persons. At large outdoor gatherings, crowded conditions, a lack of hand-washing facilities, and poor sanitation might contribute to the potential for disease transmission (1,2).

Epidemiologic and laboratory investigations are under way to identify potential sources of hepatitis A virus infection and modes of transmission. Several patients have reported close contact with other ill patients during the incubation period, suggesting that person-to-person transmission might play an important role in the spread of the infection. On the basis of early findings in this investigation, vaccination and education campaigns were held at two recent concert events. Approximately 300 attendees were vaccinated, and several contacts were administered postexposure prophylaxis.

The three bands that infected persons most commonly followed completed their summer concert tours in early August. However, fall tours are scheduled to begin in September. Concert attendees are advised to wash their hands frequently with soap and water, particularly after using the bathroom and before eating; to cook their food and drink only potable water; and to avoid food or drugs that could have been prepared under unsanitary conditions or handled by an infected person.

On July 9, the Colorado Department of Public Health and Environment first notified all other states and CDC of a possible cluster of hepatitis A among concert attendees; CDC requested reports of similar cases from other health departments. CDC plans to continue enhanced surveillance for additional cases. Because of the relatively long incubation period for hepatitis A (15--50 days), persons exposed at summer concerts might not become symptomatic until early fall, and transmission could continue with the start of fall tours. CDC requests that young to middle-aged adults with newly diagnosed hepatitis A be asked if they have attended a "jam band" concert or any outdoor concert and associated camping event. Cases of hepatitis A among concert attendees or their infected contacts should be reported to CDC through state or local health departments, and available serum should be saved for molecular testing at CDC. In addition, health departments are encouraged to contact CDC's Division of Viral Hepatitis, telephone 404-371-5419, about cases of hepatitis A that might be related to these concerts.

Reported by: P Grande, Tri-County Health Dept, Englewood; A Cronquist, MPH, Colorado Dept of Public Health and Environment. S Fernyak, MD, S Huang, MD, I Bihl, San Francisco Dept of Public Health; E Osvald-Doppelhauer, Trinity County Health and Human Svcs Dept, Weaverville; C Woodfill, PhD, D Vugia, MD, G Agyekum, MPH, California Dept of Health Svcs. J Kravitz, MD, Washington County Dept of Health and Human Svcs, Hillsboro; H Gillette, MPH, Oregon Dept of Human Svcs. G Armstrong, MD, P George, MPH, L Finelli, DrPH, Div of Viral Hepatitis, National Center for Infectious Diseases; P Patel, MD, N Jain, MD, EIS officers, CDC.

This report is based on data contributed by D Krouse, MD, C Huang, T Doppelhauer, C Merwin, Trinity County Health and Human Svcs Dept, Weaverville, California. P Cieslak, MD, M Priedeman, MPH, M Sistrom, MSN, M Grumm, MPH, L Duncan, Oregon Dept of Human Svcs. D Portnoy, MPH, San Francisco Dept of Public Health, California. R Vogt, MD, L Dippold, MPH, Tri-County Health Dept, Englewood, Colorado. O Nainan, PhD, W Kuhnert, PhD, Div of Viral Hepatitis, National Center for Infectious Diseases, CDC.

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