Two people have died in the outbreak including a man in his late 60s who had pre-existing conditions. “This is the biggest outbreak we would have had since hepatitis A was endemic in Australia, which is really before reticulated sewerage came into being,” said Victoria’s acting chief health officer, Dr Brett Sutton. The event is linked to an outbreak in Europe that in recent years has affected hundreds of people, mostly men who have sex with men. While authorities are confident local infections are now slowing, they have extended a free vaccination program to June next year and have expanded it to homeless rough sleepers and adult prisoners after a spate of cases affecting those groups. Those most at risk from contracting the infection in Victoria are gay or bisexual men, or injecting drug users.

Hepatitis A usually spreads through infected objects, food or water, but transmission can also occur through sharing injecting equipment and sexual activity. The Alfred hospital’s director of HIV medicine Professor Jenny Hoy said clinicians had been offering vaccinations to many gay male patients since February this year, and she welcomed the extension of the state-funded program. The inoculation is not routinely offered in Australia through standard childhood vaccinations, but Professor Hoy said it had been discovered that some people were already immune, having received injections ahead of travelling to Asia, South America and Africa. “If you’ve had the two doses six-months apart that gives you life-long immunity,” she said. The infectious diseases specialist said hepatitis A symptoms could vary dramatically, and some people may not even realise they have it. The Alfred has also seen a number of people hospitalised with the infection this year, and in extreme cases sufferers can go into liver failure, she said.

Professor Hoy said hepatitis A turned some people's skin yellow, and others felt intense nausea and lost their appetite. “Their stools go pale initially … People lose their taste for coffee and smoking, and lethargy is something that is quite marked,” she said. “So people can feel rather lousy.” Dr Sutton said one of the reasons why the outbreak had taken time to contain was that it could take more than a month for people to develop symptoms that also included dark urine. In the meantime, they were spreading it to their close contacts, he said.