Since November 2017, the Indiana State Department of Health (ISDH) has been investigating an outbreak of acute hepatitis A virus (HAV). Cases have been infected with HAV strains genetically linked to outbreaks across the United States. Indiana has an average of 20 cases of hepatitis A per 12 month period.

Indiana is one of serveral states experiencing a hepatitis A outbreak, and outbreak-related cases have been confirmed across the state. Information on other outbreaks can be accessed from the Centers for Disease Control and Prevention (CDC) website. Transmission is presumed to occur person to person; no contaminated commercial food product has been identified. Based on CDC guidelines, populations who are homeless, transient, incarcerated or use illicit drugs and their close direct contacts are considered at increased risk of exposure to hepatitis A.

If you believe you have been exposed to hepatitis A or are homeless, use injection or non-injection drugs, were recently incarcerated, or had contact with someone who has hepatitis A, contact your healthcare provider about hepatitis A vaccine.

To reduce the risk of hepatitis A transmission, people who have not received two doses of hepatitis A vaccine may ask their healthcare providers for protection. Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers and before preparing meals for yourself and others. Do not attend work or school if you are experiencing symptoms of hepatitis A, which include nausea, vomiting, diarrhea, loss of appetite, tiredness, stomach ache, fever, dark-colored (cola) urine, light-colored stool and jaundice (yellowing of skin and eyes). Symptoms may take as many as 50 days from exposure to appear.

Patrons who ate at Hardees restaurant on Little Rock Road in Charlotte between June 13 and 23 should receive a hepatitis A vaccination as soon as possible.

Public Health Director Gibbie Harris announced today that the outbreak identified by the State and Centers for Disease Control (CDC) earlier this month in Mecklenburg County has led to five additional cases since June 6, including a Hardees employee diagnosed Monday.

“After consulting with the State today, we are recommending a vaccination for exposed employees and patrons who ate at the 2604 Little Rock Road location between June 13 and 23,” Harris said. “According to the CDC, the vaccine must be given within 14 days of exposure for the vaccine to be effective.”

Public Health vaccination clinics for customers who might have been exposed and for residents who meet the high-risk factors for hepatitis A will be held:

  • Wednesday, June 27 from 8 a.m. – 7.p.m, and Thursday, June 28 from 8 a.m. – 5 p.m., at Northwest Health Department, 2845 Beatties Ford Rd. and Southeast Health Department, 249 Billingsley Rd., Charlotte.
  • Friday, June 29 from 3 p.m. – 8p.m. at the Hal Marshall Building, 700 N. Tryon St., Charlotte.
  • Saturday, June 30 and Sunday, July 1 from 10 a.m. – 3 p.m. at the Hal Marshall Building, 700 N. Tryon St, Charlotte.

People who dined at Hardees on Little Rock Road on June 13 and 14 are strongly urged to get a vaccination in the next two days.

Public Health announced June 6 that North Carolina Public Health officials and the CDC declared an outbreak of the liver disease in Mecklenburg County. Five additional cases of hepatitis A have been identified for a total of ten confirmed cases since April 20. Those who have had a hepatitis A infection, or one hepatitis A vaccination, are protected from the virus and do not need to take action.

The high-risk factors include:

  • Those who are household members, caregivers, or have sexual contact with someone who is infected with hepatitis A
  • Men who have sexual encounters with other men
  • Those who use recreational drugs, whether injected or not
  • Recent travel from countries where hepatitis A is common
  • Homeless individuals who do not have easy access to handwashing facilities

The best ways to prevent hepatitis A include:

  • Get the hepatitis A vaccine;
  • Practice safe handwashing procedures – wash your hands under warm, soapy water for at least 20 seconds after using the bathroom or changing diapers and before you prepare food, and
  • Wear a condom during sexual activity.

Public Health staff continues to work with medical providers and community partners to educate residents about how to prevent hepatitis A and to implement a plan to educate and encourage vaccination of those most at-risk of contracting the virus.

Since 2012, hepatitis A virus cases have been on the rise across the country. Between July 2016 to November 2017, the CDC reports 1200 cases have occurred nationally, including 826 hospitalizations and 37 deaths.  Outbreaks have occurred in California, Utah, Kentucky, Michigan, Indiana, and West Virginia.

What to know about hepatitis A

  1. It’s a highly contagious liver disease caused by a virus spread from person to person. The illness can last for weeks to months. Only acute cases are reportable in North Carolina.
    2. Hepatitis A spreads through the fecal-oral route, most commonly by forgetting to wash your hands after using the bathroom or changing diapers, having sexual contact with infected partners and eating or drinking foods contaminated by hepatitis A.
    3. Hepatitis A symptoms include nausea, fever, yellowing of the eyes and skin, dark urine, grey feces, joint pain, feeling tired, loss of appetite and stomach pain.
    4. The best way to prevent hepatitis A is to get the hepatitis A vaccine and to practice safe handwashing procedures – wash your hands under warm, soapy water for at least 20 seconds after using the bathroom or changing diapers and before you prepare food.
    5. Again, the most at-risk groups for hepatitis A are people who come into contact with someone who has hepatitis A, travelers to countries where hepatitis A is common, men who have sexual contact with men, people who use drugs (both injection and non-injection) and people with clotting factor disorders.

If you have potentially been exposed to hepatitis A and are unable to receive the vaccine watch for the symptoms listed above.  If you experience any of these symptoms, access medical care as soon as possible.

Hardee’s may be found at fault for allowing an employee to work while infected with HAV, for failing to properly supervise, train, or monitor their employees who prepare food for consumption, or for failing to require its food-service employees to obtain HAV immunizations.

Bill Marler, foodborne illness expert and food safety attorney, has been an avid advocate for strengthening preventative measures within the food industry. “Any exposure to hepatitis A is entirely preventable,” Marler said. “By not requiring employees to be vaccinated against the virus, Hardee’s puts itself and all of its customers at risk. Infected people typically don’t show symptoms until a few weeks after contracting hepatitis A, so they could be spreading the virus without even knowing it. However,” he continued, “Had all employees been vaccinated, Hardee’s wouldn’t have to worry about identifying HAV positive employees in the first place, and customers wouldn’t be panicking now to receive treatment.”

Exposed employees and customers are filing for damages that include wage loss, medical-related expenses, travel expenses, emotional distress, fear of harm and humiliation, and physical pain and injury.

The acute symptoms of hepatitis A are a sudden onset of flu-like symptoms about a month after the virus is contracted. Muscle aches, headaches, loss of appetite, abdominal discomfort, fever, and jaundice are all typical symptoms of the infection. Urine may turn a dark color and stool could be light or clay-colored. The illness typically lasts a few weeks, but recovery could take up to a year. Most affected individuals show complete recovery within three to six months of the onset of illness. Relapse is possible, although it is more common in children than adults.

The best protection against a hepatitis A infection is to get vaccinated. An estimated 80,000 cases of HAV occur each year, although much higher estimates have been proposed. Hepatitis A is a virus that primarily infects the liver, and an estimated 100 people die each year as a result of acute liver failure in the U.S. due to hepatitis A. However, the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Because HAV is so readily transmitted, Bill Marler encourages restaurants and food handlers to adhere to strict sanitary protocols. He warns, “The virus is almost exclusively transmitted through fecal-oral contact, so it is crucial that all employees thoroughly wash their hands after using the restroom, whether they feel sick or not.” For more information about hepatitis A, please visit www.about-hepatitis.com.

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