4 new cases; it’s unclear how some became ill
By Barbara Isaacs
HERALD-LEADER STAFF WRITER
Health department investigators yesterday tracked four new cases of hepatitis A, expanding a Fayette County outbreak that has now sickened 14 people.
Disease investigators, called epidemiologists, were still trying to determine how some of the victims became ill.
Some of those connections between victims are obvious. The first reported cases were among an extended family in two households. The family’s toddler was exposed to hepatitis A while traveling outside the United States. The family’s kindergartner, who attends Mary Todd Elementary, passed it to two classmates. Then a neighbor of the family got the disease.

But it has been harder to connect the dots in the case of a pre-schooler at Yates Elementary, who was diagnosed earlier this week. That child doesn’t have any known connection to the ill people. Two newly diagnosed adults also don’t have a known connection.
“Epidemiologists are kind of like reporters,” said Dr. Kraig Humbaugh, Kentucky’s director of epidemiology and health planning. “They find the medical who, what, when, where, why and how in a public health incident.”
T.J. Sugg, regional epidemiologist for the Lexington-Fayette County Health Department, said that none of the sick adults works in food service. “We’re happy about that,” he said. Infected food service workers have often been a focal point of hepatitis A outbreaks.
Sugg said the investigation is continuing.
Humbaugh said the health department has taken correct steps so far. For instance, the investigators have contacted the household and other close contacts of the ill people.
Then they gave those people an injection of immune globulin, which helps the body fight off a hepatitis A infection if a person has been recently exposed. They’ve also vaccinated hundreds of people who have had contact with the infected people.
Disease investigators are checking into the past month of the sick people’s lives, looking to find similarities, such as eating at a particular restaurant or event, or places they have visited.
Humbaugh said it’s often difficult to find links because most people can’t remember every meal they’ve eaten in the past month or every place they’ve gone. “But the more information they can give, the more likely they are to find commonalities.”
Hepatitis A has a long incubation period — on average, 28 days, but people can harbor the virus for as long as 50 days before they show symptoms.
Humbaugh said that people with hepatitis A can infect others during the 10 days before they show symptoms and for the first week they have yellow skin and eyes, known as jaundice. After the first week of jaundice, people with hepatitis A may still have yellow skin and eyes and other symptoms, but they don’t transmit the virus to others.
Hepatitis A is spread by putting something in the mouth that is contaminated with the fecal matter of someone infected with the virus.
The 14 cases in Fayette are considered an outbreak because they represent many more cases than is normal. Last year there were just two reported cases in the county.
Lexington recently experienced another epidemic related to fecal contamination — shigellosis. More than 190 people were sickened in last summer’s outbreak, which was confined mostly to day-care centers.
Humbaugh said other than the obvious — both diseases involve ingesting fecal matter — there’s no connection. He pointed out that other areas of the state have also had hepatitis A outbreaks, including Calloway County last summer.
Though hepatitis A usually is a relatively mild disease, it can spread rapidly, as recent Kentucky history shows.
Fayette County had 19 cases in 1994, with about half of them among workers at several restaurants and a private dining room. Health officials gave immune globulin shots to about 200 people who were thought to have been exposed. No schools were affected.
An even larger Northern Kentucky outbreak in 1994 made more than 90 people sick. Health officials eventually traced that incident to a food-service worker at a Covington catering company who unknowingly had the disease and spread it to customers. Up to 1,000 people in Ohio and Northern Kentucky might have been exposed, officials said at the time.
Sometime in the future, there could be fewer outbreaks of hepatitis A because of recent changes to childhood vaccination recommendations.
Late last year, the Centers for Disease Control and Prevention added the hepatitis A vaccine to the list of those recommended for children at age 1. They get two doses at least six months apart.
“There was a general agreement that there was a need, that there was enough of it in this country,” said Dr. Chris Nelson, a pediatric infectious disease specialist at the University of Kentucky.
The vaccinations mean that, as those babies grow up, they will be immune to the virus and won’t be able to spread it.
Nelson said that frequent and thorough hand washing is enough to protect people from the virus.
“It’s the primary way we get sick,” Nelson said. “As long as people have good hand sanitation and take the standard precautions, the general public has nothing to worry about. Most people don’t come in contact with other people’s fecal material.”
Staff writer Jim Warren contributed to his report.