Closer Look: Kentucky battling hepatitis A outbreak
The Hepatitis A outbreak has hit at least four surrounding counties — Bourbon, Fayette, Madison and Montgomery — and about 32 counties total across the state.
“Luckily we haven’t seen an uptick in cases in Clark County yet,” Jennifer Burchett, clinic nurse administrator at the Clark County Health Department, said. “Kentucky continues to have cases pop up all across the state. Louisville has been hit the hardest and so has far east Kentucky.”
The surrounding counties have had anywhere from one to four reported cases of hepatitis A from Aug. 1, 2017, to April 28, 2018, according to data released by the Kentucky Department for Public Health (KDPH).
In late April, Montgomery County health officials confirmed five hepatitis A cases, including a McDonald’s food handler. The restaurant was inspected, and no additional people experienced symptoms during that time.
Since August, the state health department has reported 448 cases and four deaths. The state averages about 20 cases a year. The CDC has been monitoring the situation closely, Burchett said.
The cases in Louisville have been traced to have a direct connection to cases in California, Burchett said. She said the bulk of those affected in Kentucky had been the homeless population and IV drug users.
How it spreads
Hepatitis A is a highly-contagious liver disease.
Illness is usually short-term and does not become chronic, Burchett said.
There are three different types of Hepatitis, all of which are caused by something different. Hepatitis A is found in the feces of people, and is spread by people not washing hands, Burchett said.
“It’s mainly spread by touching contaminated surfaces and putting your hands near your mouth,” she said.
It’s frequently transmitted by eating or drinking something that has been contaminated with fecal matter — typically because someone with the virus hasn’t properly washed their hands after going to the toilet before handling the food or beverage.
“One reason the homeless population has been hit so hard is because they don’t have as many places to wash their hands,” Burchett said. “So, it spreads more easily.”
Hepatitis A can also be spread through sex, illicit drug use and sharing cigarettes, food, beverages and more.
It does not spread through sneezing or coughing.
Burchett said it’s important to note that the risk of contracting Hepatitis A at a restaurant is low.
“I think it’s very good to emphasize that the CDC contracting Hepatitis A from a food worker is a very low-risk exposure,” she said.
The most common symptoms of hepatitis A are fatigue, low-grade fever, loss of appetite, joint pain, sudden nausea and vomiting, yellow eyes or skin, abdominal pain, pale stools and dark urine, according to the Centers for Disease Control and Prevention.
“It’s going to feel worse than the average 24-hour stomach bug,” Burchett said.
A person with the virus is contagious for up to two weeks before showing symptoms. An infected person is most contagious during the two weeks before their skin turns yellow.
Symptoms usually last less than two months, but some people could remain sick for up to six months. Burchett said it can vary from person to person.
The virus attacks the liver, stopping it from ridding the body of toxins, which could lead to death. Though, the risk of it leading to death is low, Hepatitis A can also block blood clotting. Anyone over age 50, young children and at-risk populations such as those with weak immune systems are at an increased risk of death if they contract the virus.
The best way to prevent the spread of Hepatitis A is proper hand-washing and getting the vaccine.
CDC recommends hand washing with soap and water after using the bathroom or changing diapers, and before preparing or eating food as the best ways to prevent an infection.
Hand sanitizers are not effective against it, so frequent handwashing is crucial in controlling an outbreak.
Hepatitis A is hard to kill and can live outside the body, according to the CDC.
People who fear they have been exposed have just 14 days to get vaccinated.
After getting the shot, it takes 14 to 28 days to gain up to 95 percent protection. The CDC recommends getting a second shot six months after the first one.
Vaccination is more critical for certain age groups such as children and adults over the age of 50. It will be a mandated vaccine for students in public school as of July 1, Burchett said. It will take a couple of weeks for the vaccine to take effect.
Burchett said other people who should consider getting vaccinated are those with other illnesses or people whose immune system isn’t working.
“High-risk folks such as the homeless, IV drug users, people with other Hepatitis infections should all be immunized,” she said.
Burchett also recommended people who work with these populations get vaccinated.
“Hepatitis A will make you very sick,” she said. “Most people don’t die from it, but if your immune system isn’t working very well, then you could die.”
The KDPH has recommended all people in some counties — Boyd, Bullitt, Carter, Greenup, Hardin and Jefferson — get the vaccine.
Burchett said if someone is interested in the vaccine, to call their insurance to ask about coverage. She said most insurances should cover the vaccine and the local health department has limited vaccines for uninsured adults.
Many pharmacies such as Walgreens and Walmart might also carry the vaccine, she said.
If someone fears they’ve been exposed, contact their physician or primary care doctor, Burchett said. And don’t panic.
“If there is a clear exposure, there is a two-week period to get the vaccine so it can help,” she said.
If someone has been exposed and four weeks have gone by, then the infection may have to run its course. Though some people who have been exposed may not experience symptoms until after two months, Burchett said.
“That’s why it’s hard to control,” she said. “Someone may not realize they have it and can be out spreading it without realizing it.”
As a primary public health rule, wash your hands, Burchett said.
It’s even more critical when out and about in public places, she said.
“It protects you from Hepatitis A, the flu,” Burchett said. “I just can’t stress that enough.”
Burchett said the Hepatitis A outbreak reports come in pockets, and she’s not sure if the outbreak is near the end of its course or if cases will continue to uptick.
“Be vigilant but don’t panic about it,” she said.