According to press reports, Arkansans state health officials are urging all food service workers in Clay County, as well as people who recently ate at one gas station in particular, to get vaccinated against hepatitis A amid an outbreak that has infected a dozen Arkansans since February.

The latest food service worker to be infected was an employee of a Subway and Flash Market gas station at 105 N. Missouri Ave. in Corning. People who ate at the business between March 30 and Tuesday should seek care immediately if they haven’t been vaccinated, the state Department of Health said in a news release.

In Indiana, health officials in Floyd County say a case of Hepatitis A has been confirmed in a food service employee.

The Floyd County Health Department says the person works at the Taco Bell located at 900 Lafollette Center in Floyds Knobs. That restaurant is about a mile north of Interstate 64 on U.S. 150. Anyone who has eaten at the restaurant between April 1 and April 18 should get the Hepatitis A vaccine before April 30 to reduce the chance of infection.

Hepatitis A is a viral infection of the liver and is highly contagious.  People become infected through contact with:

  • Shared syringes used to inject drugs
  • Foods prepared or served by infected persons
  • Stool or blood of infected persons
  • Inanimate objects that may have trace amounts of fecal material from hand contact.

The symptoms, which can vary greatly from severe to none at all, may include:

  • Loss of appetite
  • Nausea
  • Tiredness
  • Fever
  • Stomach ache
  • Dark (cola) colored urine
  • Light colored stools.

Jaundice, the yellowing of the eyes or skin, may appear a few days after the onset of symptoms.

Persons can become ill 15-50 days after being exposed to the Hepatitis A virus. Most people feel sick for several weeks, but they usually recover completely and do not have lasting liver damage.

Final update as of April 11, 2018.

With the slowdown in reported hepatitis A cases across California, CDPH has demobilized the outbreak response and continues to monitor reported hepatitis A cases statewide.  While CDPH might receive additional reports of outbreak-associated hepatitis A cases, CDPH has entered a new phase where monitoring of cases and prevention activities, such as vaccinating the at-risk population (people experiencing homelessness and/or using illicit drugs in settings of limited sanitation), have been shifted from emergency response to day-to-day operations. CDPH greatly appreciates the monumental efforts of federal, state, and local government partners, especially local public health departments and their community partners, as well as private partners, to control this large hepatitis A outbreak.  We encourage partners to continue providing hepatitis A vaccination for people experiencing homelessness, along with other high-risk groups, including people using illicit drugs and men who have sex with men.

Below is a summary of the outbreak and CDPH response as of April 11, 2018.  Any subsequent hepatitis A cases reported to CDPH will be included in our annual surveillance reports.

No future website updates of this page are planned.

The outbreak began in San Diego County in November 2016 and spread to Santa Cruz, Los Angeles, and Monterey counties.  To date, San Diego and Santa Cruz have reported the greatest number of cases, and in addition to cases in Los Angeles and Monterey counties, other counties have reported 17 outbreak-associated cases. The majority of people who have been infected with hepatitis A virus in this outbreak are people experiencing homelessness and/or using illicit drugs in settings of limited sanitation.  Other states are experiencing outbreaks in similar populations of at-risk people.  Following intensive efforts by local health departments and their clinical and community partners, including vaccination campaigns targeting the at-risk population, education, obtaining and managing vaccine, and many other interventions, the number of reported outbreak-associated cases has substantially decreased in California.

CDPH has helped to support the local health department response in the following ways:

  1. Coordinating and supporting hepatitis A outbreak response efforts across California and supporting the Governor’s declaration of a state of emergency to secure and purchase vaccine in a time of vaccine constraint.
  2. Monitoring the outbreak and providing epidemiologic support to the response by enhancing monitoring of cases, testing specimens to identify the outbreak strain, and providing staff and technical expertise, including developing and disseminating disease control, clinical, and vaccine prioritization guidance.
  3. Buying, distributing, and monitoring hepatitis A vaccine – to date, CDPH has distributed about 123,000 vaccine doses to local health departments during this outbreak.
  4. Communicating accurate information about the outbreak, control measures, and level of risk of hepatitis A infection for different populations with partners, the media, and the public.
​Jurisdiction ​Cases ​Hospitalizations ​Deaths
​San Diego ​587 402 20
​Santa Cruz 76 ​33 ​1
​Los Angeles ​12 8 ​0
​Monterey ​12 ​10 ​0
​Other 17 ​8 ​0
​Total 704 461 21

Since January 1, 2017, Utah public health has identified 233 confirmed cases of hepatitis A virus (HAV) infection; many among persons who are homeless and/or using illicit drugs. Several cases have been linked by investigation and/or viral sequencing to a national outbreak of hepatitis A involving cases in California and Arizona. Hospitalization rates of less than 40% have been described in previous hepatitis A outbreaks; however, other jurisdictions associated with this outbreak are reporting case hospitalization rates approaching 70%. The high rate of hospitalization may be a result of cases having underlying illnesses (e.g., alcoholism), or a higher rate of hepatitis comorbidities (e.g., hepatitis B or C). In response to the outbreak, public health officials have been working to identify cases and contacts, provide education, and ensure opportunities for vaccination of close contacts to cases and vulnerable populations.

Hepatitis A is usually spread through having oral contact with items contaminated with hepatitis A, for example, through ingesting food or drinks contaminated by infected feces. Some people do not develop symptoms, even if infected. If symptoms occur, they usually appear anywhere from 2-6 weeks after exposure. Symptoms usually develop over a period of several days, and may include jaundice (the yellowing of the skin or whites of the eyes), abdominal pain, nausea or diarrhea. Hepatitis A vaccination is the best way to prevent hepatitis A infection.

Last updated 04/09/18

Outbreak-Associated Cases 217
2017 149
2018   68
Deaths – 2 in Salt Lake City

Public health officials and the Michigan Department of Health and Human Services (MDHHS) are continuing to see an elevated number of hepatitis A cases in the state.

Since the beginning of the outbreak in August 2016, public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. No common sources of food, beverages, or drugs have been identified as a potential source of infection. Transmission appears to be through direct person-to-person spread and illicit drug use. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate.

Michigan Hepatitis A Outbreak Cases and Deaths as of April 4, 2018

Cases Hospitalizations Deaths
802 644 (80.4%) 25 (3.1%)

 

 Confirmed Cases Referred August 1, 2016-April 4, 2018 
Meeting the MI Hepatitis A Outbreak Case Definition
 County (or city) Total Cases  County (or city) Total Cases
 Macomb 216  Sanilac 6
 City of Detroit 167  Lapeer 6
 Wayne 138  Livingston 6
 Oakland 108  Grand Traverse 4
 St. Clair 30  Allegan 1
 Ingham 24  Clare 1
 Washtenaw 17  Hillsdale 1
 Monroe 17  Huron 1
 Genesee 13  Ionia 1
 Isabella 8  Kent 1
 Calhoun 7  Leelanau 1
 Shiawassee 7  Lenawee 1
 Eaton 5  Newaygo 1
 Clinton 3  Schoolcraft 1
 Gratiot 3  Van Buren 1
 Saginaw 3  Other* 1
 Mecosta 2

 *Jackson Michigan Department of Corrections

 

 

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 148 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of Mar. 3, 2018

§  Total Outbreak: 148

§  Hospitalizations: 107

§  Deaths: 1

New cases the week of Feb. 25 – Mar. 3: 23

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 103 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

State laboratory tests confirmed this week that five cases of the Hepatitis A virus reported in Northern Lower Michigan have officially been linked to the larger Southeast Michigan Outbreak of Hepatitis A. Four of these cases have been reported in Grand Traverse County and one in Leelanau County.

Since August 1, 2016, there have been 677 cases of Hepatitis A identified across the state, primarily in southeastern Michigan. 82% of the cases have been severe enough to lead to hospitalization. Both the Grand Traverse County Health Department and the Benzie-Leelanau Health Department are working with state officials and participating in the State’s Community Health Emergency Coordination Center (CHECC) to monitor Hepatitis A cases, as well as spread awareness about Hepatitis A in our community.

Hepatitis A can be a serious and contagious liver disease. Although not all people infected with the Hepatitis A virus experience illness, symptoms can include: nausea and vomiting, abdominal pain, feeling tired/fatigue, fever, joint pain, loss of appetite
, yellowing of the skin and eyes dark urine and 
pale-colored feces.

Hepatitis A virus often spreads by eating contaminated food or water, between sexual partners, or through close personal contact while living with an infected person. Individuals that are at a higher risk for getting the Hepatitis A virus include the following: the homeless or those living with transient housing, persons who are incarcerated, illicit drug users (both injection and non-injection drugs), persons who have sexual activities with someone infected with Hepatitis A virus, men who have sexual relations with men, and persons who have close contact, care for, or live with someone who has the Hepatitis A virus.

The Hepatitis A virus is vaccine preventable. While the vaccine is recommended as a part of the routine childhood vaccination schedule, many adults have not yet been vaccinated. “We recommend that everyone be vaccinated against Hepatitis A,” said Wendy Hirschenberger, Health Officer for Grand Traverse County Health Department. The best way to reduce the risk of getting Hepatitis A is to get vaccinated. It is also recommended to regularly wash your hands after using the bathroom and before preparing meals for yourself and others. In addition, don’t share toothbrushes or eating utensils, do not have sex with someone who has a Hepatitis A infection, and do not share food and/or drinks with other people.

Individuals who believe they have been exposed to Hepatitis A or who have symptoms consistent with the virus, should contact their healthcare provider immediately. Anyone who wants to be vaccinated should contact their healthcare provider or their local health department: Benzie-Leelanau Health Department at 231-256-0200 Grand Traverse County Health Department at 231-995-6131 Health Department of Northwest Michigan 800-432-4121

The confirmation of five cases of Hepatitis A in northern Michigan has prompted the Grand Traverse County Health Department to host special clinic hours to offer vaccinations to the community today (Saturday) from 10am to 1pm at the department’s offices at 2600 LaFranier Road.

The vaccination will be offered to individuals with or without insurance; those who can’t afford the vaccination or don’t have insurance can receive it for free. Hepatitis A is a serious, highly contagious liver disease caused by the Hepatitis A virus (HAV). The virus can be spread through contaminated food or water, sexual contact, or by living with an infected person. The illness can appear 15-50 days after exposure and last for several weeks. In some cases, Hepatitis A can be fatal.

Other upcoming extended clinic walk-in hours for vaccinations at the Grand Traverse County Health Department include:

Wednesday, February 21: 4:30pm-6:30pm
Wednesday, February 28: 7am-8am
Wednesday, March 7: 4:30pm-6:30pm
Wednesday, March 14: 7am-8am
Wednesday, March 21: 4:30pm-6:30pm
Wednesday, March 28: 7am-8am

The Wyoming Department of Health (WDH) and the Casper-Natrona County Health Department continue to investigate a growing Natrona County hepatitis A outbreak that began in October.

Since October, 14 cases have been confirmed among Natrona County residents, which is a significant increase over the usual total for Wyoming. Previously, the long-term average statewide was two cases annually with the last reported local Hepatitis A infection in 2012.

“While some of the Natrona County cases did not have a clear hepatitis A exposure risk, recent cases have been concentrated among current injection drug users,” said Clay Van Houten, Infectious Disease Epidemiology Program manager with WDH.

Infection with hepatitis A typically results in symptoms in older children and adults.

Symptoms usually occur abruptly and include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stools, joint pain and jaundice.

There can be a significant delay between when someone who is exposed to the virus and when they show symptoms.

“People recently exposed to hepatitis A who have not been vaccinated should receive a vaccine as soon as possible,” Van Houten said.

Specific risk factors for hepatitis A include:

  • Persons with direct contact with a person who has hepatitis A
  • Men who have sex with men
  • Users of injection and non-injection drugs
  • Travelers to countries with high rates of hepatitis A infectionHepatitis A can cause infection in the liver. The virus is primarily spread person-to-person through oral contact with contaminated items such as swallowing food or drink tainted with a tiny amount infected feces.

Van Houten said the best way to prevent hepatitis A is through vaccination.

Handwashing, especially after using the bathroom, changing diapers, and before preparing or eating food, plays an important role in preventing the spread of the virus.

Vaccination to prevent hepatitis A is routinely recommended.

Children aged at least 12 months and less than 24 months should receive two doses of the vaccine separated by at least 6 months and no less than 18 months.

The vaccine series is also recommended for people aged 2 years or older who have not already received it.

The Casper-Natrona County Health Department offers the hepatitis A series vaccine; some people may qualify for free or discounted vaccine.

The Detroit Health Department recommends all food establishments get their employees vaccinated.

To support this effort, the Detroit Health Department is launching a mobile vaccination clinic program to provide easy and convenient access for Detroit food establishments to vaccinate their employees.

The Department will set up clinics throughout the City of Detroit, where clusters of restaurants are located.

Restaurants can call the Detroit Health Department at 313-876-0135 to arrange for vaccination.

Southeast Michigan has seen 692 hepatitis A cases, with 564 hospitalizations resulting in 22 deaths in the last year.

Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces, or stool, of an infected person.