Hundreds get shots; state declares hep A outbreak
by Angie Newsome, ANEWSOME@CITIZEN-TIMES.COM
August 30, 2006

ASHEVILLE — As 250 restaurant goers lined up Tuesday at the Buncombe County Health Center for free immune globulin shots, state and local health officials investigated a mini outbreak of hepatitis A in Buncombe and Madison counties.

Medical Director Dr. Susan Mims said a total of four hepatitis A cases were confirmed in Buncombe County in August, adding to two others confirmed in April and July. Officials also recently confirmed two cases in Madison County.

On Tuesday, officials offered the first of two shot clinics organized after two cases were confirmed on Monday. Officials estimate that a sick employee exposed just more than 1,300 people who ate at Trevi Restaurant & Gourmet Market between Aug. 17 and Friday. They ask that those who ate there at that time go to the health center for free immune globulin shots, a serum that can prevent or help reduce symptoms of the illness if it is administered within two weeks of exposure. The second clinic was scheduled for today.

Symptoms include fever, chills, abdominal pain, nausea, vomiting, diarrhea, yellowing of the eyes and skin and dark urine. They appear about 30 days after exposure but can occur up to 50 days later.

“The state is calling this a small outbreak in a regional sense and trying to link this to other cases across the country,” Mims said.

Mims and Dr. Kristina Simeonsson, a medical epidemiologist with the N.C. Department of Health and Human Services, said some of the cases are unrelated.

But investigators are researching whether some people with confirmed cases were exposed to the illness at a gathering at a Madison County farm that lasted throughout the summer, a Rainbow Gathering in Steamboat Springs, Colo., in July or Phil Lesh and Friends concerts held along the East Coast, Mims said.

Officials say get the shot
Sixty-one cases of the illness, which is a liver disease, have been confirmed across the state as of Tuesday, Simeonsson said.

The cases are confirmed like this: A sick patient goes to his or her doctor. If a physician suspects that the patient has hepatitis A, he or she tests the patient with an antibody test known as an IgM test, which indicates acute infection. It is sent to a lab, which confirms the illness.

When it is confirmed — or even before — physicians are required to contact health officials to report the illness.

And though public health officials say it is still unknown whether the Trevi worker exposed anyone to the illness, they encourage those who may have been in contact with him to get the shot. The booster lasts for about three months.

Trevi co-owner Dale Wolfe said Tuesday that the management team of the Biltmore Village restaurant took the sick employee to the hospital when they learned he was ill. That employee had worked there only seven days, Wolfe said.

“He did not return, he has not been allowed to return and he doesn’t work here anymore,” he said.

Where does it come from?
But customers weren’t too hard on the restaurant as they stood in line for shots on Tuesday.

“It’s a great restaurant,” said Eric Penland, who carried his 2-year-old son Ayden with him to get shots. “There’s nothing they (the owners) could have done.”

“I’m sure it has happened at other places,” Asheville resident C.B. Ryans said as he filled out paperwork before getting his shot. “It’s just something that happens.”

But just where people get the virus is another question. Statistics show that most cases are not directly linked to sick food workers.

Citing a May CDC report, Simeonsson said 13 percent of all cases are contracted through sexual or household contact. Thirteen percent come from international travel. Mims said 2 percent to 3 percent come from restaurant exposures. The rest are hard to pinpoint.

Mass shot clinics, such as the one the Buncombe County Health Center is holding, are also unusual. The latest was held in Dare County in July, following a similar case where a food worker was confirmed to have the illness.

Consider the vaccine
That may be an even bigger reason to consider the vaccine.

“Now that we have the hepatitis A vaccine, the best way to prevent having to stand in another immune globulin line like this is to go ahead and get the vaccine,” Mims said. “The more people we vaccinate in the community, the less we’ll have these exposures.”

Mims said the CDC now recommends that all children get the vaccination. The vast majority of hepatitis A cases, she said, come from children, who tend to have no or very few symptoms.

And public health officials pay to keep hepatitis A from spreading.

The national cost of paying for shot clinics and other types of preventative measure was about $300 million in 1997, Mims said, citing CDC data. Average costs, both directly and indirectly, range from $1,817 to $2,459 per adult and $433 to $1,492 per child.

And many local restaurant goers may not have forgotten the 2003 outbreak in which 16 people came down with the illness. About 3,600 people who ate at two local restaurants — Doc Chey’s Noodle House and the Laughing Seed Cafe — got the shot at that time.

An investigation eventually found the source to be contaminated green onions from Mexico, linking the local cases to those found in Georgia, Tennessee and Pennsylvania.

And before that, in 1998, another case of hepatitis A found in a La Paz restaurant worker also caused the center to organize a shot clinic.

That may be hard news for diners who relish their favorite dishes at their favorite eatery.

Take Asheville resident Chris Scavone, who said one thought crossed her mind when she first heard about the confirmed case: “I would never feel the same about shrimp a la vodka.”

Hand washing is key to preventing spread of hepatitis A
Question: What is hepatitis A?

Answer: It’s a liver disease caused by the hepatitis A virus.

Q: How is it transmitted?

A: Usually, it’s spread from person to person by putting something in your mouth that has been contaminated with the stool of a person with hepatitis A. It can be passed through other bodily fluids, such as saliva.

Q: How can I protect myself from the virus?

A: Wash your hands. Thoroughly washing your hands with soap and running hot water for at least 15 seconds kills the virus.

Q: How sick could I get?

A: You could feel miserable for weeks. Three of every four adults who get hepatitis A have wide-ranging symptoms. They usually come on suddenly, and new symptoms can develop as the illness progresses. Symptoms can last for as long as six months. Early symptoms, which last three to 10 days, include nausea, vomiting, chills fever, extreme fatigue and loss of appetite. Between 20 and 50 percent of those infected will develop yellow eyes and skin (jaundice) and dark urine.

Q: How do you know you have hepatitis A?

A: A blood test is needed to diagnose the virus.

Q: True or False: Once you’ve had hepatitis A, you cannot get it again.

A: True. There is no long-term infection. After you’re infected with hepatitis A, your body develops immunity to it. About 15 percent of people infected with hepatitis A will have prolonged or relapsing symptoms over a six- to nine-month period.

Q: What are the differences between an immune globulin shot and the hepatitis A vaccine?

A: An immune globulin shot offers short-term protection for about three months. It must be given within two weeks after exposure to hepatitis A. The hepatitis A vaccine provides long-term protection for at least 20 years. It consists of two shots given six months apart.

Q: What is immune globulin?

A: It is a preparation of antibodies (proteins produced by white blood cells) that will help your body destroy the virus.

Q: Are there any side effects to immune globulin shots or the vaccine?

A: Allergic reactions rarely occur. Some people may feel tender or see swelling near the injection point.

Q: Is it safe for children to be vaccinated or receive an immune globulin shot?

A: The vaccine for hepatitis A can safely be given to people 2 years of age or older. People of all ages can get immune globulin shots.

Q: If I’m pregnant, is it safe to be vaccinated or get an immune globulin shot?

A: Yes.

Sources: Centers for Disease Control and Prevention and the Buncombe County Health Center

Contact Angie Newsome at 828-232-5856 or via e-mail at anewsome@ashevill.gannett.com.