by Kate Evans
An outbreak of acute hepatitis A in West Virginia has brought cases closer to this area in the last week.
Two cases were reported last week in Berkeley County and a third case is now confirmed there, said Berkeley County/Morgan County Health Department nurse Angie Gray. One suspected case is currently being investigated in Morgan County.
The number of acute hepatitis A virus cases in West Virginia from a multi-state outbreak soared from 121 confirmed cases on May 24 to 404 cases as of June 29, according to information from the West Virginia Bureau of Public Health.
Some 280 people – accounting for nearly 70% of the cases – have been hospitalized. One person infected died in Kanawha County.
No cases have occurred yet in Jefferson, Hampshire, Mineral, Hardy, Grant and Pendleton Counties. The number of West Virginia counties affected by the outbreak jumped from eight to 17 counties since May.
The majority of the hepatitis A cases have occurred in Kanawha County (233 cases) along with 73 cases in Cabell County, 54 cases in Putnam County, 13 cases in Wayne County and five cases in Mason County. Counties that have reported fewer than five cases are Berkeley, Boone, Calhoun, Greenbrier, Jackson, Lincoln, Logan, Mercer, Nicholas, Raleigh, Randolph and Wyoming.
Most of the increase in cases since March 2018 has occurred in IV and non-IV drug users, homeless or transient/mobile individuals, those recently incarcerated or individuals co-infected with hepatitis C, according to West Virginia Bureau of Public Health information.
Viral sequencing has linked cases from Kentucky and California. A history of drug use has been noted in around 70% of the confirmed state cases.
According to Center of Disease Control and Prevention (CDC) information, Arkansas, California, Indiana, Kentucky, Michigan, Missouri, Ohio, Tennessee, Utah and West Virginia are involved in the outbreak.
A West Virginia health advisory noted that 1,300 of 2,500 multi-state hepatitis A case investigations reported to the CDC from January 2017 to April 2018 where risk factors were known had drug use and/or homelessness.
Gray said that there has been an increase in blood to blood transmission hepatitis A cases and that only 15% of the cases are homeless. Here the virus is occurring in blood-borne person to person transmission. Usually most cases are spread by the fecal-oral route, which includes close household contact with someone with the hepatitis A virus.
Their mission is to vaccinate those who are at the highest risk for hepatitis along with first emergency responders who have contact with them, Gray said. That includes EMS, firefighters, law enforcement, correctional officers and Health Department staff and volunteers. They’ve vaccinated individuals at the day report center and homeless shelters.
Hepatitis A
“Hepatitis A is a serious, highly contagious liver disease caused by the hepatitis A virus (HAV). HAV is found in the feces of people with hepatitis A. You can contract hepatitis A by eating food, drinking water, or putting something in your mouth that has been contaminated with fecal matter from a person infected with hepatitis A,” said Toby Wagoner, West Virginia Bureau of Public Health Communications Officer.
“Hepatitis A is easily spread through close sexual contact and household contacts as well as through persons who share injection and non-injection drugs. Illness can appear 15-50 days after exposure and a person can be sick for several weeks. In some cases, people can die,” he added.
Not all people infected with hepatitis A experience illness. Symptoms can include nausea and vomiting, belly pain, feeling tired, fever, loss of appetite, yellowing of the skin and eyes, dark urine, pale-colored feces, and joint pain. Most people recover fully after illness.
Gray said that testing is only done for hepatitis A if someone has signs and symptoms of the disease. All health care providers are mandated to report any hepatitis A cases to the Health Department within 24 hours. They want to vaccinate all contacts of someone with the disease.
Prevention
Food establishments are directed to ensure that employees are washing their hands before preparing food and after restroom use and using safe food handling practices such as wearing gloves when preparing food.
Surfaces must also be cleaned and disinfected since the hepatitis A virus can live on surfaces for weeks. Alcohol-based hand sanitizers aren’t effective against killing the virus.
Gray said that washing foods carefully, especially fruits and vegetables, and staying home when sick are also important.
Vaccinations
Individuals that are at the highest risk should be vaccinated against hepatitis A. Those include persons that use injected and non-injected recreational drugs, homeless people, men who have sexual contact with other men and those that have been recently incarcerated in the past six weeks.
Young children receive their hepatitis A vaccination at age one as part of their childhood immunization schedule. Parents should review their child’s vaccination status and make sure that all children age 12 months or older have had both doses of the hepatitis A vaccine, which are given six months apart.
The CDC advises that the following groups also be vaccinated against hepatitis A: travelers to countries that have high rates of hepatitis A; family members and caregivers of recent adoptees from countries where hepatitis A is common; people with chronic lifelong liver diseases such as hepatitis B or hepatitis C; those that are treated with clotting-factor concentrates and individuals that work with hepatitis A infected animals or in a hepatitis A research laboratory.
Berkeley County Health Department’s website noted that the CDC Advisory Committee on Immunization Practices recommends that persons who are at increased risk for infection or complications from hepatitis A or anyone wishing to obtain immunity/ protection also be vaccinated. Gray said they recommend that anyone get vaccinated.
Anyone who thinks they have been exposed to the virus should call or see a health professional right away as the virus can be easily spread one to two weeks before symptoms show.
Contact the Morgan County Health Department at 304-258-1513 or call a health care provider for more information about whether you or your child needs the hepatitis A vaccination.
