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.

Likely Linked to broader hepatitis A outbreak in area.

Salt Lake County Health Department (SLCoHD) announced today that customers of the 7-Eleven convenience store at 2666 West 7800 South in West Jordan who used the restroom at the store or consumed certain items on specific dates should contact the health department for information about receiving an injection to prevent hepatitis A. This possible exposure affects only this single 7-Eleven location.

The preventive injection recommendation is for customers who visited the store on any date from Tuesday, December 26, through Wednesday, January 3, and who used any restroom in the store or consumed any of the following items:

  • Fountain drink or other self-serve beverage
  • Fresh fruit
  • Any item from the store’s hot food case, such as pizza, hot dogs, chicken wings, or taquitos

Packaged items, including bottled beverages and microwaved foods, are NOT implicated in the possible exposure. Customers who consumed only packaged or bottled items do not need to contact the health department. Customers who are fully vaccinated (two doses) against hepatitis A also do not need to contact the health department.

Customers who used the store restroom or consumed any of the items listed above on any of the dates indicated should call 385-468-INFO (4636) for further instructions. The phone line will be staffed form 8:00 a.m. to 5:00 p.m. beginning Monday, January 8. Health department staff will screen callers for their exposure risk and provide them with options for receiving a prophylactic hepatitis A vaccine.

People in need of prophylaxis must receive it within a short time period of their possible exposure, so it is essential that affected customers call the health department as soon as possible. Based on average sales volume for this store, health officials estimate up to 2,000 customers may be affected.

The possible hepatitis A exposure occurred when an infected employee worked while ill and potentially handled certain items in the store. SLCoHD believes this case is linked to the ongoing outbreak Salt Lake County has been experiencing since August 2017. 7-Eleven is cooperating fully with the health department’s investigation and response and, since discovering the possible exposure, has sanitized the affected store according to health department recommendations.

“This is an important reminder to food service establishments that they should consider vaccinating their food-handling employees against hepatitis A,” said Gary Edwards, SLCoHD executive director. “It’s also important that food handlers be conscientious with hygiene, hand washing and not working when ill—and that managers be vigilant in enforcing those important requirements that help protect public health.”

Hepatitis A vaccine is covered by most insurance plans and is widely available at local pharmacies, health care providers and SLCoHD immunization clinics. Call 385-468-SHOT (7468) for an appointment at a health department immunization clinic.

Since January 1, 2017, Utah public health has identified 141 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.

There has been a confirmed case of hepatitis A in Eaton County, the Barry-Eaton District Health Department announced Wednesday.

The health department says the individual is being treated and is not at high risk of spreading the disease.

It is the first known hepatitis A case in Eaton County this year, but it is not yet known whether the case is connected to a more widespread outbreak in southeastern Michigan, the Barry-Eaton health department said.

A Detroit Free Press analysis determined Michigan had the highest per capita rate of hepatitis A cases among U.S. states, with more than 500 Michigan cases reported in 2017. Most of those cases occurred in Detroit and Macomb County.

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.