Hepatitis A Watch

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Erie County officials are urging anyone who recently ate at Destiny’s on Fillmore in Buffalo to be vaccinated for Hepatitis A after the virus was identified in a worker at the restaurant.

According to Erie County Executive Mark Poloncarz, anyone who at as a dine-in or takeout customer between February 27, 2019 and March 11, 2019 is eligible to recieve a free Hepatitis A vaccine provided by the Erie County Department of Health. The vaccine clinics will be held on March 13 and March 14, from 3 pm to 8pm, at the Elim Christian Fellowship located at 70 Chalmers Avenue in Buffalo.

Officials say people who ate at the restaurant between February 9 and February 26 may have been exposed but will “not benefit from Hepatitis A vaccine to prevent infection from this exposure.” Everyone is encouraged to monitor their health for symptoms for 50 days after consuming food from the establishment.

The Erie County Department of Health has provided the following information on Hepatitis A.
Symptoms of Hepatitis A can include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored stools
• Joint pain
• Jaundice (yellowing of the skin and eyes)

• Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from no symptoms at all, to a mild illness lasting a few weeks, to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people.
• Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. This can happen from eating at a restaurant, sharing food or drink, or eating when traveling in one of the many countries outside the United States with a high Hepatitis A infection rate.
• People who are most at risk of Hepatitis A include:

– People with direct contact with someone who has a hepatitis A infection. This can occur up to 2 weeks before the infected person develops any symptoms, so you may not be aware of your exposure at the time.
– Travelers to countries where hepatitis A is common, which include most countries outside the United States. More information is available on the Centers for Disease Control and Prevention’s web site.
– Men who have sexual contact with men,
– People who use drugs, both injection and non-injection drugs, and
– Homeless individuals

People who are considered high risk for exposure to the Hepatitis A virus should get vaccinated as soon as possible to avoid contracting the virus and lessen the spread of the disease. High risk groups include individuals who use illicit drugs, close contacts of illicit drug users, and homeless people.

The Department for Public Health (DPH) is making this recommendation as part of its efforts to respond to the ongoing outbreak of Hepatitis A. Since the outbreak began in August 2017, reported cases continue to rise and have now been recorded in 103 of Kentucky’s 120 counties.

“If you are at-risk of exposure to the Hepatitis A virus, we urge to get vaccinated immediately. Immunizations can be obtained from a healthcare provider, pharmacies, and clinics throughout the state. Local health departments have limited vaccine supply for at-risk individuals who are uninsured,” said DPH Commissioner Dr. Jeff Howard. “In addition, if you live in a county currently experiencing an outbreak, we also urge you to be vaccinated for Hepatitis A as well as continue to practice regular and thorough hand washing, particularly if you are engaging with any of the high risk groups.”

About 80 percent of cases in the current outbreak are people in the high risk groups. Other priority populations include;

People with direct contact with someone who has Hepatitis A (particularly during their infectious period);
Men who have sexual contact with men; and
People who are at increased risk of complications from Hepatitis A (e.g., people with chronic liver disease).
As of Jan. 26, 3,819 cases have been reported in Kentucky due to the outbreak. A recent year-end review of Kentucky mortality records revealed additional deaths, increasing the total known deaths to 40 associated with the current Hepatitis A outbreak. Counties have reported 1,862 hospitalizations due to Hepatitis A.

To date, 80 counties have reported five or more cases, meaning they meet the threshold for what is considered an outbreak of Hepatitis A virus. Boyd, Carter, Fayette, Floyd, Jefferson, Kenton, Laurel, Madison, and Whitley counties report 100 or more cases associated with the outbreak.

Hepatitis A is a highly contagious, vaccine-preventable disease of the liver, which causes inflammation of the liver and affects the organ’s ability to function. Signs and symptoms of Hepatitis A include nausea, diarrhea, and loss of appetite, fever, fatigue, jaundice (yellowing of the skin or eyes), clay-colored bowel movements, dark-colored urine, and abdominal discomfort. Signs and symptoms usually appear 2-4 weeks after exposure, but may occur up to 7 weeks after exposure. Children under 6 years of age with Hepatitis A often show few signs and symptoms.

Hepatitis A virus is found in the stool of infected people, and is usually spread person-to-person when infected people do not properly wash their hands or do not have access to proper sanitation. Transmission typically occurs when a person ingests infected fecal matter, even in microscopic amounts, from contact with contaminated objects, food, or drinks. DPH recommends frequent hand washing, particularly after using the restroom, or before eating, to prevent transmission of hepatitis A and many other common diseases.

To prevent new cases from occurring, DPH has partnered with local public health staff, health care providers, correctional facilities, faith-based organizations, homeless shelters, and substance abuse treatment centers to vaccinate people who are at the highest risk of getting Hepatitis A. People who have had Hepatitis A disease or previously received 2 doses of the Hepatitis A vaccine do not need to be immunized.

“Vaccination of high risk groups is crucial to stopping the outbreak in Kentucky,” added Dr. Howard. “If you or someone you know might be at risk for Hepatitis A, please get vaccinated as soon as possible at your local health department, primary care physician’s office, or local pharmacy. If you suspect you might have Hepatitis A infection or are experiencing symptoms (including, vomiting, diarrhea, jaundice/yellowing of the skin and eyes), you should seek medical care immediately.”

Individuals also are advised to contact their local health department or the Reportable Disease program at DPH at (502) 564-3261.

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended that all children receive the Hepatitis A vaccine series. DPH recommends children aged 1 to 18 years receive the two-dose Hepatitis A vaccine, as well as at-risk adults. Kentucky now requires all students in kindergarten through 12th grade to have two doses of the Hepatitis A vaccine in order to attend school or receive a provisional certificate of immunization.

A new case of hepatitis A has been diagnosed in a Frankfort food worker, the Franklin County Health Department reports.

The infected individual worked at the KFC located on at 1229 US 127 between Oct. 22 and Oct. 25.

The health department wants to remind the public that it’s rare for restaurant patrons to become infected with hepatitis A virus due to an infected food handler. However, for anyone who consumed food or drink at that KFC location during that time should receive a vaccination by Nov. 8.

Vaccinations are being administered at the Franklin County Health Department located at 100 Glenns Creek Road on the following dates and times:

Monday-Tuesday: 8 a.m. to 11 a.m., 1:30 p.m. to 3:15 p.m.
Wednesday: 8 a.m. to 11 a.m., 1:30 p.m. to 5:15 p.m.
Thursday-Friday: 8 a.m. to 11 a.m.

Anyone who ate there during that time frame should monitor their health for symptoms up to 50 days after exposure.

Careful hand washing, including under the fingernails, with soap and water, along with vaccination of anyone at risk of infection, will prevent the spread of this disease.

Northeast Arkansas continues to have an ongoing hepatitis A (hep A) outbreak. Hep A is a contagious liver disease that can be prevented by a vaccination. The ADH is warning of a possible hep A exposure after an employee of Arkansas State University (ASU) food service and volunteer at Salvation Army has tested positive for the virus.

Anyone who ate at the ASU Student Center or the Salvation Army at 800 Cate Avenue in Jonesboro from Oct. 13 to Oct. 24 should seek vaccination immediately if they have never been vaccinated against hep A or are unsure of their vaccination status. There are no specific treatments once a person gets hep A. Illness can be prevented even after exposure by getting the vaccine or medicine called immune globulin. This medicine contains antibodies to hep A and works best if given within two weeks of exposure to the virus.

Vaccine will be available Thursday Oct. 25 and Friday Oct. 26 from 8 a.m. to 4:30 p.m. at the Craighead County Local Health Unit in Jonesboro at 611 E. Washington Ave. Vaccine will also be available at the ASU Reng Student Center (3rd floor River Rooms) located at Aggie Circle on campus in Jonesboro from 8 a.m. to 5 p.m. on Monday, Oct. 29 and Tuesday, Oct. 30. The vaccine will be provided to the public at no cost. People should bring their insurance card and driver’s license if they have one. Students who will are unable to attend the clinics listed above because they are traveling for the weekend may be able to visit a Local Health Unit in another county. Those visiting Local Health Units in other counties should call ahead to ensure vaccine is available. Local Health Unit listing can be found at https://www.healthy.arkansas.gov/health-units.

Anyone experiencing symptoms should seek care immediately. Typical symptoms of hep A include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, or jaundice (yellowing of the skin or eyes). It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

Risk of getting hep A in a food service setting is low. Restaurants must follow ADH protocols for handwashing and glove use, and employees are not to return to work until they are no longer sick. Hep A is being spread in this outbreak primarily through close contacts in the community, not through eating at restaurants.

Since February, 178 cases of hep A have been reported as part of an outbreak in Northeast Arkansas, including one death. Greene County has had the most cases, although there have been cases in Arkansas, Clay, Cleburne, Craighead, Independence, Lawrence, Lee, Mississippi, Monroe, Phillips, Poinsett, and Randolph counties.

High priority groups for getting the hep A vaccine include:

  • Anyone who has had close contact with someone who has hep A
  • Food workers
  • People who use drugs, whether injected or not
  • People experiencing homelessness, transient, or unstable housing
  • People who have been recently incarcerated

The hep A vaccine is safe and effective. Hep A is a contagious liver disease that results from infection with the hep A virus, which is a different virus from the viruses that cause hep B or hep C. It is usually spread when a person ingests tiny amounts of fecal matter from contact with objects, food or drinks contaminated by the feces (stool) of an infected person.

A person can transmit the virus to others up to two weeks before and one week after symptoms appear. If infected, most people will develop symptoms three to four weeks after exposure; however, the virus can cause illness anytime from two to seven weeks after exposure. Many people, especially children, may have no symptoms. Almost all people who get hep A recover completely and do not have any lasting liver damage, although they may feel sick for months.

Older people typically have more severe symptoms. Other risk factors for having more severe symptoms of hep A include having other infections or chronic diseases like hep B or hep C, HIV/AIDS, or diabetes. Up to one in three adults are typically hospitalized. Death due to hep A is rare, but is more likely in patients with other liver diseases (like hep B or hep C).

Northeast Arkansas continues to have an ongoing hepatitis A (hep A) outbreak. Hep A is a contagious liver disease that can be prevented by a vaccination. The ADH is warning of a possible hep A exposure after an employee of Murdocks Catfish, located at 2612 Red Wolf Blvd in Jonesboro, tested positive for the virus.

Anyone who ate food from this restaurant from Sept. 27 to Oct. 5 should seek vaccination immediately if they have never been vaccinated against hep A or are unsure of their vaccination status. There are no specific treatments once a person gets hep A. Illness can be prevented even after exposure by getting the vaccine or medicine called immune globulin. This medicine contains antibodies to hep A and works best if given within two weeks of exposure to the virus.

“This restaurant worked proactively with the ADH by requiring vaccination for all of their employees with complete compliance prior to this potential exposure,” said Dr. Dirk Haselow, State Epidemiologist. “ADH is not aware of any ongoing risk in this restaurant at this time.”

Vaccine will be available at the Craighead County Local Health Unit located at 611 E. Washington St. in Jonesboro from 8 a.m. to 6 p.m. Thursday, October 11, and at the Earl Bell Community Center located at 1212 S. Church St. in Jonesboro from 8 a.m. to 6 p.m. Friday, October 12.  The vaccine will be provided to the public at no cost. People should bring their insurance card and driver’s license if they have one.

Anyone experiencing symptoms should seek care immediately. Typical symptoms of hep A include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, or jaundice (yellowing of the skin or eyes). It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

Risk of getting hep A in a restaurant setting is low. Restaurants must follow ADH protocols for handwashing and glove use, and employees are not to return to work until they are no longer sick. Hep A is being spread in this outbreak primarily through close contacts in the community, not through eating at restaurants.

Since February, 158 cases of hep A have been reported as part of an outbreak in Northeast Arkansas, including one death. Greene County has had the most cases, although there have been cases in Clay, Craighead, Independence, Lawrence, Lee, Mississippi, Monroe, Phillips, Poinsett, Arkansas, and Randolph counties.

The ADH continues to encourage all Greene County residents who are age 19 to 60 to get vaccinated for hep A and wash their hands thoroughly and often. The ADH strongly encourages all food handlers to be vaccinated against hep A in Greene, Clay, and Craighead counties to protect against spread of the virus.

High priority groups for getting the hep A vaccine include:

  • Anyone who has had close contact with someone who has hep A
  • Food workers
  • People who use drugs, whether injected or not
  • People experiencing homelessness, transient, or unstable housing
  • People who have been recently incarcerated

The hep A vaccine is safe and effective. Hep A is a contagious liver disease that results from infection with the hep A virus, which is a different virus from the viruses that cause hep B or hep C. It is usually spread when a person ingests tiny amounts of fecal matter from contact with objects, food or drinks contaminated by the feces (stool) of an infected person.

A person can transmit the virus to others up to two weeks before and one week after symptoms appear. If infected, most people will develop symptoms three to four weeks after exposure; however, the virus can cause illness anytime from two to seven weeks after exposure. Many people, especially children, may have no symptoms. Almost all people who get hep A recover completely and do not have any lasting liver damage, although they may feel sick for months.

Older people typically have more severe symptoms. Other risk factors for having more severe symptoms of hep A include having other infections or chronic diseases like hep B or hep C, HIV/AIDS, or diabetes. Up to one in three adults are typically hospitalized. Death due to hep A is rare, but is more likely in patients with other liver diseases (like hep B or hep C).

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.

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.

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