In San Diego California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.

In Michigan, since August 2016, there have been 457 confirmed cases of hepatitis A – including 18 deaths. These have occurred in Huron, Ingham, Lapeer, Livingston, Macomb, Monroe, Oakland, Sanilac, St. Clair, Washtenaw, and Wayne counties. Of the confirmed cases, 85 percent of patients were hospitalized. On October 30th, Little Caesars Pizza store and Firewater Bar and Grill employees were implicated.  Cardamom restaurant was implicated on October 5th.

The Wayne County Department of Health, Veterans and Community Wellness is investigating cases of Hepatitis A related to two Grosse Pointe restaurants.

The restaurants are Uncle Paul’s Pizza on Mack Ave. and Cabbage Patch Cafe and Catering on Kercheval Avenue.

Both establishments have voluntarily closed and are working with WCDHVCW during the investigation.

WCDHVCW is advising people who consumed food from these establishments between Aug. 1 and Sept. 29, 2017 to watch for symptoms of Hepatitis A which can include abdominal pain, nausea, vomiting, diarrhea, dark urine, clay colored stool, fever, chills, yellow skin and eyes (jaundice).

Symptoms occur between 15 and 50 days after exposure and can last for several weeks to months.

Public Health Announces Hepatitis A Outbreak in LA County  – Hepatitis A vaccine is the best protection

The Los Angeles County Department of Public Health (Public Health) has declared a local outbreak of hepatitis A (HAV) in Los Angeles County because the most recent new cases appear to be locally acquired.Hepatitis A outbreaks are currently ongoing in San Diego and Santa Cruz counties. The large majority of cases have occurred in persons who are homeless and/or use illicit drugs (injection and non-injection), with several cases also occurring among people who provide services to the homeless.

Public Health has confirmed 10 total cases of hepatitis A among high-risk individuals (those that are homeless or in institutions that serve the homeless) in Los Angeles County. Of the confirmed cases, four had been in San Diego and one had been in Santa Cruz during their exposure period. Three secondary cases occurred in a health care facility in Los Angeles County. The two most recent cases appear to have acquired their infection locally within Los Angeles County.

“Public Health has been proactively preparing for an outbreak for some time and is working diligently to prevent spread in local communities. Our priorities are to keep all our residents both safe and well informed of the situation,” said Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County. “Vaccination is the best protection against Hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals.”

A person can get hepatitis A if they come into contact with an infected person’s feces through contaminated food or objects. The hepatitis A virus can spread when a person does not properly wash their hands after going to the bathroom or changing diapers. Other modes of transmission include certain sexual practices, sharing equipment related to illicit drug use, and consumption of food or water contaminated with the virus. People who are homeless are at higher risk because they face challenges to maintaining good hygiene.

Physicians are required to report HAV cases to Public Health. HAV causes acute liver disease, which may be severe. It is transmitted by contact with feces from a person who is infected – often through contact with food or water or during sex or other close contact. Signs and symptoms of acute HAV include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than 2 months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination or administration of immune globulin within 2-weeks following exposure. If you experience these symptoms, contact your physician.

Although Hepatitis A is very contagious, you can take the following steps to prevent Hepatitis A:

  • Get vaccinated for Hepatitis A
  • Don’t have sex with someone who has Hepatitis A infection
  • Use your own towels, toothbrushes and eating utensils
  • Don’t share food, drinks, or smokes with other people
  • Wash hands with soap and water after using the bathroom, changing diapers, and before preparing, serving or eating food.

Public Health continues surveillance for cases and is working closely with healthcare providers and organizations that serve the homeless population to protect the health of patients/clients, staff and the community. Public Health is providing education and vaccination to the homeless and those who work with them, and working with other organizations that provide services for the homeless population to reach this community. Hepatitis A vaccination is available at Public Health clinics or from your health care provider. County residents may call the LA County Information line at 2-1- 1 from any landline or cell phone within the county for referrals to providers offering vaccines at no-cost or a reduced cost. For patients without access to HAV vaccine, Public Health will have vaccine available at its Public Health Centers located throughout the County.

The death toll in an outbreak of hepatitis A in San Diego has reached 16, and 421 people have been sickened with the disease, the county Health and Human Services Agency reported Today. The figures are associated with an outbreak that began last November and has struck the homeless population and users of illicit drugs particularly hard.

Patients who contracted hepatitis A, which attacks the liver, in a manner unrelated to the outbreak aren’t included in the statistics.

The new numbers were released the same day the city of San Diego began a pilot program to keep 14 public restrooms in Balboa Park open 24 hours a day. Under direction from county health, the city on Monday began washing down streets and sidewalks in the East Village with a bleach formula.

Also, around 40 hand-washing stations were set up around the city — concentrated in areas where the homeless congregate — around the beginning of the Labor Day weekend.

County officials, meanwhile, are continuing a program of vaccinations, which are considered to be the best way to prevent hepatitis A. The disease is spread by contact with microscopic amounts of infected feces and via sexual transmission.

More than 7,000 shots have been given to people considered to be at-risk of acquiring the disease, and over 19,000 shots given out in total.

In January’s annual tally of the area’s transient population, 5,619 homeless individuals were counted in the city of San Diego, a 10.3 percent increase from last year. Of those, 3,231 were living on the streets.

Thanks to HepMag.com for a great summary of ongoing hepatitis A outbreaks going on in the US.

California

Public health officials first detected the hepatitis A outbreak in November 2016 and as of July 21, 2017, 251 cases and 5 deaths have been reported in San Diego. Those affected have largely been homeless individuals, which has made public health efforts more challenging to implement, particularly in reaching individuals with vaccinations and improving hygiene practices. Local officials and community organizations have been working to raise awareness of hepatitis A vaccination, distribute “Hepatitis A Prevention Kits” (containing sanitary supplies), and plans are underway to install hand-washing stations in areas frequented by homeless persons to help stop the spread. Since the outbreak began, the county has administered over 4,000 hepatitis A vaccinations, and more work is planned to expand those efforts. With this combined approach, San Diego is hoping to end the outbreak, the largest in California in nearly 20 years.

Colorado

Between January and early July 2017, 43 cases of hepatitis A were reported in Colorado, a significant increase from 2016 where 23 cases were reported for the full year. Half of these cases resulted in hospitalization and one person has died. Unlike many hepatitis A outbreaks, there is no apparent common link to a restaurant or food item. 74% of hepatitis A cases are men and at least half are men who have sex with men (MSM). Local public health agencies are working to battle the epidemic by targeting MSM with outreach and offering vaccination at a variety of sites.

Michigan

Between August 2016 and June 2017 in southeast Michigan, almost 200 people have been diagnosed with hepatitis A infection, 90% of those infected have required hospitalization, and 10 people have died. Public health officials believe the outbreak to be unrelated to water or food contamination, but rather person-to-person spread through use of illicit drugs, sexual contact, and close proximity. Nearly 50% of those infected report a history of substance use disorders and 20% are also infected with hepatitis C.

Oakland County Health Division reports eight new cases of Hepatitis A in the last week associated primarily with the Farmington Hills area. The Health Division has not yet identified a source, but is investigating potential common factors such as contaminated food, sick individuals, travel, and healthcare exposure.

“These new cases serve as a vital reminder of why it is critical to get vaccinated,” said Leigh-Anne Stafford, health officer for Oakland County. “The Health Division urges all residents, food handlers, and healthcare providers to get the Hepatitis A vaccine and to wash hands thoroughly. Ill food workers and health care workers are encouraged to stay home from work, seek medical attention, and report their illness to their employer.”

Dr. Pamela Hackert, medical director for Oakland County Health Division said, “The virus is shed in feces and is most commonly spread from person to person by contaminated hands. In addition to vaccination, good hygiene, proper sanitation of surfaces, and proper food preparation are keys in preventing this contagious disease.”

Hepatitis A is an infection of the liver caused by a virus and is a vaccine-preventable disease. Symptoms of Hepatitis A include sudden abdominal pain, fatigue, diarrhea, nausea, headache, dark urine, and vomiting followed by yellowing of the skin and eyes. Symptoms may appear from two to six weeks after exposure, with the average time being about one month. In rare cases, those with a pre-existing severe illness or a compromised immune system can progress to liver failure. Individuals are advised to contact their doctor if they have a sudden onset of any symptoms.

To reduce the risk of contracting Hepatitis A:

  • Wash hands frequently, especially after using the bathroom, changing diapers, and before preparing and eating food. Rub hands vigorously with soap and warm running water for at least 20 seconds. Handwashing is essential and one of the most effective ways to prevent the spread of infection.
  • Clean and disinfect all surface areas if someone in the household or workplace has symptoms, especially areas such as toilets, sinks, trashcans, doorknobs and faucet handles.
  • Do not prepare food if you have symptoms and refrain from food preparation for at least three days
  • after symptoms have ended, or two weeks after onset of clinical symptoms, whichever is longer.
  • Get the Hepatitis A vaccine.

The Hepatitis A vaccine is available through some health providers, CVS Minute Clinics, Oakland County Health Division offices in Southfield and Pontiac, and many pharmacies. Call ahead to ensure your health care provider or pharmacy has the vaccine available.

Health Division offices are located at the following addresses:

  • North Oakland Health Center, 1200 N. Telegraph Road, Building 34 East, Pontiac
  • South Oakland Health Center, 27725 Greenfield Road, Southfield

Payment options include cash and credit card. There is a $5 fee per visit, per client as well as additional fees for credit card payments. Vaccine fees are charged to individuals who are not eligible for federal and/or state programs that cover vaccination costs. The Vaccines for Children (VFC) Program offers vaccines at no cost for eligible children up to 18-years-old. If you have insurance, check with your health care/insurance provider for possible benefit coverage. No one will be denied access to services due to inability to pay. A discounted/sliding fee schedule is available.

For more information about Hepatitis A, visit www.oakgov.com/health or call Nurse on Call at 800-848-5533, Monday through Friday, 8:30 a.m. – 5:00 p.m.

From August 1, 2016 to March 21, 2017, 107 cases of lab-confirmed hepatitis A have been reported to public health authorities in these jurisdictions. This represents an eightfold increase during the same time last year. Ages of the cases range from 22 to 86 years, with an average age of 45 years. The majority of the cases have been male. Eighty-five percent of the cases have been hospitalized with two deaths reported.  Approximately one-third of the cases have a history of substance abuse, and 16 percent of all cases are co-infected with hepatitis C. No common sources of infection have been identified.

Hepatitis A is a vaccine-preventable disease. While the hepatitis A vaccine is recommended as part of the routine childhood vaccination schedule, most adults have not been vaccinated and may be susceptible to the hepatitis A virus.

Hepatitis A vaccination is recommended for:

  • All children at age 1 year
  • Close personal contacts (e.g., household, sexual) of hepatitis A patients
  • Users of injection and non-injection illegal drugs
  • Men who have sex with men
  • People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C. Persons with chronic liver disease have an elevated risk of death from liver failure
  • People who are treated with clotting-factor concentrates
  • Travelers to countries that have high rates of hepatitis A
  • Family members or caregivers of a recent adoptee from countries where hepatitis A is common

Individuals with hepatitis A are infectious for 2 weeks prior to symptom onset. Symptoms of hepatitis A include jaundice (yellowing of the skin), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools. Symptoms usually appear over a number of days and last less than 2 months; however, some people can be ill for as long as 6 months. Hepatitis A can sometimes cause liver failure and death.

Risk factors for a hepatitis A infection include living with someone who has hepatitis A, having sexual contact with someone who has hepatitis A, or sharing injection or non-injection illegal drugs with someone who has hepatitis A. The hepatitis A virus can also be transmitted through contaminated food or water.

333 ill, 11 deaths with 232 hospitalized.

Since early 2017, the Public Health Services Division, in the County of San Diego Health and Human Services Agency, has been investigating a local Hepatitis A outbreak. The majority of people who have contracted hepatitis A are homeless and/or illicit drug users, although some cases have been neither.  The outbreak is being spread person-to-person and through contact with a fecally contaminated environment.  No common sources of food, beverage or drugs have been identified that have contributed to this outbreak, though investigation is ongoing.  

Vaccination efforts are being implemented in targeted locations by County staff and in collaboration with health care partners. Health providers are asked to inform the Epidemiology Program if they have a patient suspected to have the hepatitis A infection, before the patient leaves the emergency department or provider’s office.

In a follow-up on the hepatitis A outbreak in San Diego County, CA, the number of cases reported this year has climbed to 312, including 10 fatalities, according to latest health department data.

Of the cases, nearly seven out of 10 patients required hospitalization for their illness (215).

The County of San Diego Health and Human Services Agency says the investigation into the outbreak is ongoing.

It has been challenging because of the long incubation period of the disease (15 to 50 days) and the difficulty experienced to contact many individuals sickened with the illness who are homeless and/or illicit drug users. To date, no common source of food, beverage, or other cause has been identified; as a result, the source of the outbreak remains undetermined.

A comprehensive hepatitis A vaccination program established in Alaska in the 1990s, which became a requirement for school entry in 2001, has virtually wiped out the virus in the native peoples of Alaska, where it had been endemic.

Data from the program is being presented at this year’s World Indigenous Peoples’ Conference on Viral Hepatitis in Anchorage, Alaska, USA (8-9 August) by Stephanie Massay, Epidemiology Specialist with the Alaska Division of Public Health, Section of Epidemiology, Anchorage, AK, USA, and colleagues.

Hepatitis A is an acute (short-term but severe) infection of the liver caused by the hepatitis A virus. Fever, weakness, nausea, aches and pains, and jaundice can be among the symptoms experienced. The hepatitis A virus can survive in the environment on and in food. It is also relatively resistant to detergents but can be inactivated by high temperature (85°C or higher) and by chemicals such as chlorine. Although it occurs worldwide, HAV occurs more commonly in populations with poor sanitation, such as poor populations in developed countries (e.g. Indigenous populations) and also in developing countries more generally.

Alaska experienced epidemics of hepatitis A every 10-15 years during the 1950s to the 1990s, resulting in thousands of cases. Alaska Native (AN) people living in rural communities were disproportionately impacted.

Hepatitis A virus (HAV) vaccines were licensed in 1995 and recommended by the Advisory Committee on Immunization Practice (ACIP) for routine vaccination of US children in populations with high HAV infection rates. Alaska began universal vaccination for children aged 2-14 years in 1996? HAV vaccination became required for school entrance in 2001. In 1997, following ACIP recommendations, this was expanded to include all children age 2 – 18 years, and in 2006 this was further expanded to include children age 1 – 18 years.

The data showed that during 1972-1995, Alaska’s average annual incidence of hepatitis A was 60 per 100,000 population. Rates by race were substantially higher for AN people compared to non-AN people (244 vs 19 per 100,000 respectively, with AN people being 13 times more likely to be infected than non-AN people).

Compared to 1972-1995 (pre-vaccine), 2002-2007 (post­vaccine) statewide hepatitis A incidence fell by 98% (0.9 vs. 60 per 100,000); among AN peoples the incidence fell by 99.9% (0.3 vs. 243.8 per 100,000). During 2008-2016, 23 HAV cases were reported in Alaska? 5 among AN, 11 among non­AN, and 7 among people of unknown race/ethnicity.

The 2008-2016 statewide incidence of hepatitis A was 0.35 cases per 100,000 people? the incidence in children aged <14 years was 0.14 cases per 100,000 children. Of the 17 cases with documentation on travel, 15 (88%) had recent travel outside of Alaska. In 2015, National Immunization Survey data estimated that among children aged 19-35 months, HAV vaccine coverage was similar in Alaska (84%) and all US children (86%).

The authors conclude: “Dramatic declines in the incidence of hepatitis A occurred after HAV vaccine was recommended as a routine childhood vaccine and after it was required for school entry. Prior to routine vaccination, most the reported HAV cases were associated with outbreaks occurring within Alaska. Since 2008 however, 88% of reported hepatitis A cases have been imported, many of which were acquired during travel outside of the United States.”