The Kentucky State Department of Health says it has seen more than 300 cases of hepatitis A in more than six counties.
Health officials say three people have died in Kentucky from a hepatitis A outbreak.
The Kentucky State Department of Health says it has seen more than 300 cases of hepatitis A in more than six counties. Officials have not released which six counties have been affected.
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LANSING, Mich. (WLUC) – The Michigan Department of Health and Human Services (MDHHS) recently issued $500,000 in grants to 25 local health departments to help combat Michigan’s hepatitis A outbreak.
Local health departments were issued $20,000 each to increase vaccination outreach to high-risk populations and include:
Share This Page The potentially deadly disease is on the rise in homeless and drug-using populations across the country.
San Diego’s huge outbreak of hepatitis A ― a preventable but deadly virus that is spread through contact with human feces ― captured national media attention in September. The city began washing streets it believed were contributing to the problem with bleach and initiated a local vaccination campaign among the communities most affected. Soon, it was out of the national conversation.
But similar outbreaks have continued throughout the country, still largely among the homeless and illicit drug-using populations who are most vulnerable to the disease, with few national headlines in sight. Meanwhile, the Morbidity and Mortality Weekly Report out of the Centers for Disease Control and Prevention ― which the agency itself calls the “voice of the CDC” ― has not provided accurate year-end numbers for hepatitis A, making the disease appear less widespread than it truly is.
Note: it’s noteworthy that science they can sequence the hepatitis A virus to connect the initial outbreak. This drives home the need to address the original outbreak before it is spread to the local and national communities – Alan
Homeless people and drug users are apparently experiencing the brunt of Kentucky’s uptick in hepatitis A virus cases.
The Kentucky Department of Public Health (KDPH) has charted the increase since Jan. 1, 2017, with 103 confirmed cases, which have included 78 hospitalizations. The seven most recent illnesses came in during the count for the week of Feb. 11-17, according to an update posted Tuesday.
The uptick in cases involving homeless people and drug users occurred since Aug. 1, 2017, according to KDPH. Viral sequencing has linked Kentucky’s cluster with hepatitis A outbreaks in California, Utah, Michigan and other states.
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Hepatitis A (HAV) Overview
In 2017 and early 2018, four states reported major outbreaks of hepatitis A (HAV) to the Centers for Disease Control and Prevention (CDC). The list below reflects the numbers provided by the CDC and news reports at the time this article went to print.
The majority of the HAV outbreaks were among the homeless population and people who inject or take drugs.
Hepatitis A (HAV) is a virus that affects the liver. It is the most common type of viral hepatitis in the United States.
HAV Transmission
Hepatitis A virus infection continues to be one of the most frequently reported, vaccine-preventable diseases in the United States. In 1997, there were 180,000 new HAV infections, but the incidence has dramatically decreased by 95% with the introduction of the HAV vaccine and increased prevention measures.
Unlike hepatitis B and C, which are spread through contact with infected blood or body fluids, hepatitis A is spread through food and water contaminated by feces (poop) of people infected with HAV. The virus is spread by hepatitis A virus-infected fecal matter that is ingested (by mouth) or through blood. The hepatitis A virus may be present even if you cannot see it (e.g., a glass of water, ice cubes, food, etc.).
HAV is also transmitted through close, personal contact such as changing diapers and through some types of sexual contact (e.g., analingus, or anal/oral sex) and, rarely, injection drug use.
This virus is extremely hearty. It can survive the body’s highly acidic digestive tract. At room temperature, HAV can live for more than a week. In water, it can survive from 3 to 10 months, which is why it is found in some shellfish in sewage-contaminated bodies of water.
Workers in day care centers and long-term care facilities, such as nursing homes, have a higher risk of getting hepatitis A, as do international travelers to areas that have substandard drinking water.
Risk factors associated with hepatitis A
HAV Prevention
To prevent transmission of HAV, adults and children must wash their hands thoroughly, especially after using the toilet or changing diapers. People infected with HAV should avoid preparing food for others. Clean up spilled blood or body fluids with a 10:1 bleach solution (10 parts water to 1 part bleach). Wear gloves when touching blood, body secretions, or any cuts or sores. Do not share razors, toothbrushes, or needles. Practice safer sex, including condoms and barriers for oral/anal sex.
HAV Symptoms and Progression
Hepatitis A has an incubation period that can be from 15 to 50 days but averages 28 days. When symptoms occur in adults, they appear suddenly and may include fever, exhaustion, loss of appetite, nausea and abdominal discomfort, dark urine, gray-colored stools (poop) and jaundice (yellowing of the skin and eyes).
Children younger than age six who become infected with HAV, usually have no symptoms. Because they are symptom-free, caregivers, parents, household members, childcare workers and other people who come into contact with infected children are at risk of contracting HAV.
Like all types of hepatitis viruses, HAV infects and inflames the liver. People at risk for more severe damage from HAV include those with chronic hepatitis C or B, the elderly, people with a compromised immune system, the homeless population, and people who inject or take drugs. There have also been outbreaks of HAV from contact with food service workers; others who some legislators have advocated for laws to require all food service workers to be vaccinated against HAV.
Hepatitis A usually resolves on its own. Symptoms usually last a few weeks, although fatigue may linger for months. About 10-15% of people experience a relapse over a 6-9 month period. There is no chronic or carrier state. A person may develop fulminant hepatitis A, which is liver failure characterized by severe symptoms and may be fatal; fulminant hepatitis A is more likely in people who already have chronic hepatitis B, hepatitis C, another liver disease, or a compromised immune system.This is why we are experiencing so many deaths. Vaccination against hepatitis A will protect people at increased risk for these complications.
HAV Treatment
Because hepatitis A typically resolves on its own, there is no standard treatment for HAV. An injection of HAV immune globulin (antibodies) given within 14 days of exposure may prevent the development of illness or lessen the severity of symptoms. During the acute period, general measures such as a healthy diet, plenty of fluids and adequate rest can help make a person feel better. In severe acute infections hospitalization may be necessary.
The HAV Vaccine
The HAV vaccine is considered safe and effective. The two-dose vaccine is administered by injection, with the second dose given 6-12 months after the first. The vaccine has demonstrated protection for 20 years, but it is estimated to protect against HAV for 40 years. Some experts believe that people with compromised immune systems (such as people with HIV or people taking immunosuppressants) may require more doses of the HAV vaccine.
There have been no serious adverse reactions attributed to the HAV vaccine. Common side effects may include soreness/tenderness at injection site, headache, and discomfort.
The recommendations for vaccination against HAV include anyone at risk of exposure to HAV, including men who have sex with men, day care center workers, and certain international travelers. People with hepatitis B or C or other types of liver disease should receive the HAV vaccine to prevent fulminant hepatitis A.
Routine mandatory vaccination of school-age children in some states has reduced the incidence of outbreaks among children. Vaccination programs have the potential to reduce future outbreaks, if not eliminate the disease. There is also a combination HAV/HBV vaccine (Twinrix) that has been FDA approved for an accelerated dosing schedule (three shots within 30 days and a booster shot after one year). People who have already been infected with hepatitis A are immune and do not need to be vaccinated.
For more information about hepatitis A and immunization, visit the following websites.
Centers for Disease Control and Prevention website on hepatitis A- https://www.cdc.gov/hepatitis/index.htm
Immunization Action Coalition- http://www.immunize.org
To read the entire newsletter, click here
Alan Franciscus is the Executive Director of the Hepatitis C Support Project and the Editor-in-Chief of the HCV Advocate Website.
Share This Page DETROIT (WWJ/AP) – Michigan health officials say the southeast part of the state is seeing a serious outbreak of hepatitis A cases.
An analysis by the Detroit Free Press found that Michigan has led the U.S. in hepatitis cases per capita this year, with more than 500 reported cases so far.
The Detroit News reports that there have been 20 deaths linked with hepatitis A in southeast Michigan since August 2016.
Share This Page SAN DIEGO (KUSI) — The death toll in an almost year-long hepatitis A outbreak in the San Diego region has reached 20, county health officials reported Tuesday.
The number is one higher than what was reported by the county Health and Human Services Agency last week.
From the beginning of the outbreak in late November last year until Thursday, 536 cases of hepatitis A were reported to the HHSA.
Share This Page 10-13-2017
SACRAMENTO – Governor Edmund G. Brown Jr. today issued an emergency proclamation that allows the state to increase its supply of hepatitis A vaccines in order to control the current outbreak. Immunizations from the federal vaccine program have been distributed to at-risk populations in affected areas, but additional supplies are needed. Today’s proclamation gives the California Department of Public Health (CDPH) authority to immediately purchase vaccines directly from manufacturers and distribute them to impacted communities.
Later today, CDPH officials will host a call for reporters regarding the current hepatitis A outbreak and efforts to increase the supply of adult hepatitis A vaccines. Credentialed media may join the 2:00 p.m. PDT call by dialing 800-230-1059; when prompted, provide the title of the call: “Hepatitis A CDPH.”
For additional information about the hepatitis A outbreak, visit the CDPH website.
The full text of the proclamation is below:
WHEREAS California is currently experiencing the largest person-to-person hepatitis A virus outbreak in the United States since the hepatitis A vaccine became available 22 years ago; and
WHEREAS several counties have declared local outbreaks due to the unprecedented number of hepatitis A virus infections, particularly among persons experiencing homelessness and some illicit drug users; and
WHEREAS vaccinating at-risk populations and improving sanitation are the most effective ways to stop the person-to-person spread of the hepatitis A virus; and
WHEREAS controlling outbreaks minimizes the risk to the public, maintains the health and safety of the people of California, and limits the health risks to at-risk populations in affected locations; and
WHEREAS the federally-funded supply of vaccines is inadequate to meet the State’s current needs, and therefore, California must directly obtain the vaccine; and
WHEREAS sustaining the timely and effective local response will require State support to provide adequate vaccines, supplies, and resources; and
WHEREAS under the provisions of section 8558(b) of the Government Code, I find that these circumstances constitute a state of emergency; and
WHEREAS under the provisions of section 8571 of the Government Code, I find that strict compliance with the various statutes and regulations specified in this order would prevent, hinder, or delay the mitigation of the effects of the outbreak.
NOW, THEREFORE, I, EDMUND G. BROWN JR., Governor of the State of California, in accordance with the authority vested in me by the state Constitution and statutes, including the California Emergency Services Act, and in particular, section 8625 of the California Government Code, HEREBY PROCLAIM A STATE OF EMERGENCY to exist in California.
IT IS HEREBY ORDERED THAT:
1. The California Department of Public Health shall take all measures necessary to obtain hepatitis A vaccines and prioritize the vaccination of at-risk individuals in affected locations.
2. All drugs and medical supply stocks intended for wholesale distribution shall be held subject to the control and coordination of the California Department of Public Health as necessary to control the hepatitis A outbreak.
3. Emergency Medical Technician-Paramedic licensees in the affected locations shall have the authority to administer the appropriate vaccines to at-risk populations. To the extent that the provisions of Health and Safety Code sections 1797.52 and 1797.21 prohibit Emergency Medical Technician-Paramedic licensees from administering the appropriate vaccines to at-risk populations, those statutes are hereby waived.
I FURTHER DIRECT that as soon as hereafter possible, this proclamation be filed in the Office of the Secretary of State and that widespread publicity and notice be given of this proclamation.
IN WITNESS WHEREOF I have hereunto set my hand and caused the Great Seal of the State of California to be affixed this 13th day of October 2017.
__________________________
EDMUND G. BROWN JR.
Governor of California
ATTEST:
__________________________
ALEX PADILLA
Secretary of State
