By J.M. Hirsch, Associated Press Writer | July 7, 2005
CONCORD, N.H. –A spike in hepatitis A infections has become an outbreak after efforts to vaccinate at-risk populations earlier this year failed to control the spread of the virus, state health officials said Thursday.
So far this year the state has confirmed 48 cases, more than half of which officials attributed to drug abuse or contact with those who abuse drugs. New Hampshire typically sees just 15 to 20 cases a year.

The spike bucks a national downward trend. In 2003, the most recent year for which data are available, there were just 7,600 hepatitis A infections nationally, the lowest ever, according to the Centers for Disease Control and Prevention.
Health and Human Services Commissioner John Stephen said New Hampshire officials have worked hard to identify and vaccinate those most at risk of contracting the virus, which causes liver disease but rarely is fatal.
“Despite those efforts, we’ve seen a pace that continues to increase and continues to concern health officials,” he said.
The national decline largely is attributed to widespread vaccination efforts, which until recently had not been considered necessary in the Northeast, said Dr. Jose Montero, state epidemiologist.
The bulk of the infections so far have been in Merrimack and Cheshire counties, where the rate of infection is more than 14 cases per 100,000 people. The national average is fewer than three cases per 100,000 people.
Hepatitis A most often is spread through fecal-oral contact, such as touching hand to mouth after using the bathroom or shaking the hands of infected people who did not wash properly.
Montero said the poor hygiene and unsafe practices that often accompany drug abuse makes addicts and those around them especially susceptible to the virus.
The drug abuse connection marks a turnaround for the state, which previously has found international travel to be the most significant risk factor in the majority of its cases, Montero said.
State health officials on Thursday urged health clinics to be aggressive about reporting suspected cases.
The state also is planning vaccination clinics and will partner with drug and alcohol treatment programs, homeless shelters, community mental health centers and hospital emergency rooms to help reach at-risk populations.
Stephen said the outbreak also should serve as a reminder to restaurants and other food industries to ensure safety practices are being followed to reduce the risk of spreading the virus.
Though New Hampshire’s rate of infection was significantly lower last year, about 2,500 people had to be vaccinated after possibly being exposed by an infected worker at a Taco Bell restaurant in Derry.
Massachusetts saw a nearly fourfold increase in hepatitis A cases from 2003 to 2004, when the total number reported rose from 259 to 999. The number of cases during last year’s spike peaked in August with 120, and the total has been dropping during the first five months of this year, with 169 reported through May.
The drop has been credited to vaccination efforts. Public health officials last year distributed more than 17,000 doses of hepatitis A vaccine in an effort to stem the spread of the disease, particularly among intravenous drug users.
Symptoms of hepatitis A, which last a week or two, can include fever, fatigue, loss of appetite, nausea and jaundice.
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On the Web:
Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/diseases/hepatitis/a/index.htm