Massachusetts Health Officials Report Hepatitis A Outbreak

A public health alert about an outbreak of hepatitis A among the homeless and people addicted to drugs went out from Massachusetts health officials Monday.

The news was delivered to local health officials in the state after 65 cases of the virus were diagnosed, leading to one death so far.

The Department of Pubic Health encouraged local health departments to work with clinics and groups serving the homeless and those with substance use disorders, especially people injecting drugs, to educate those populations on the risks and make vaccines available.

A call between the DPH and local health boards has been scheduled for Wednesday.

“We have seen a spike in cases of hepatitis A, with outbreaks being reported in at least 10 other states in similar populations, constituting thousands of cases nationwide,” said Public Health Commissioner Monica Bharel, in a statement. “As part of our statewide response here in Massachusetts, we are reaching out to all local health departments to encourage and assist their efforts to provide education and vaccinations for people at risk.”

Hepatitis A is a viral infection that affects the liver and can cause fever, fatigue, loss of appetite, stomach pain and nausea, among other symptoms.

More than 20 cases were diagnosed during the first two weeks of September. Forty-five percent, or 30, of the cases detected in Massachusetts so far were in Boston, but DPH said the number of cases outside the city in Southeast and Greater Boston metro area was increasing. Many of those infected have also showed signs of hepatitis C, a blood-borne infection common among intravenous drug users that can exacerbate symptoms, health officials said.

According to the DPH and the Boston Public Health Commission, hepatitis A is commonly transmitted through contact with food or drinks contaminated by stool, making those living in unsanitary conditions particularly vulnerable.

The BPHC said the spike in case in the city is “not linked to infected persons who have traveled outside of Boston or contaminated food or water.”

The agency is recommending vaccinations for at-risk populations and those who may come in contact with at-risk populations, and said there are “intensive efforts” underway to prevent the spread of the virus.

“Vaccination and good hygiene, especially washing hands with soap & warm water, are the most effective ways to prevent the spread of hepatitis A. We are working with partners to directly reach at-risk populations and provide vaccinations, to reduce the spread of hepatitis A,” said Dr. Jenifer Jaeger, director of the Infectious Disease Bureau at the BPHC.

Back to School Amidst Hepatitis A Outbreaks

There is still no end in sight for the multiple hepatitis A outbreaks that are sweeping across the United States.

This week, a new outbreak was declared in the state of Massachusetts. According to health officials, there have been 65 cases of hepatitis A and 1 death reported since April. State ewpidemiologist, Catherine Brown, DVM, MSc, MPH, has indicated that so far, the cases are isolated in illicit drug users and homeless people.

While the threat to the public is low at this time, there have been a high number of cases reported in individuals who were previously exposed to hepatitis C, suggesting that this outbreak strain is stronger than the typical hepatitis A strain, according to Dr. Brown.

Outbreak cases are also being reported in Missouri, where 192 cases have been confirmed since September 2017. According to state health officials, injection and non-injection drug users are increasingly vulnerable to hepatitis A in this outbreak.

Although the majority of cases reported in the 11 outbreaks across the United States have been occurring in homeless populations and people who inject drugs (PWIDs), that is not always the case.

As children return to the classroom for the 2018-2019 school year, schools across the nation are advocating for the hepatitis A vaccination after being notified of cases of the virus infecting students.

In Hamilton Township, New Jersey, located near Contagion®’s home base, a letter was sent home to all parents in the district warning of 2 cases of hepatitis A that had been confirmed in students. The school district called on all parents to contact a health care provider to minimize their child’s risk of becoming infected with the virus. The district also offered free vaccines to children who were uninsured.

Hepatitis A is a cause for concern in young children because in many cases, no symptoms are experienced. The hepatitis A vaccine—an inactivated vaccine that requires 2 doses for long-lasting protection—was first recommended in the United States in 1996.

Since the vaccine has been recommended, the number of hepatitis A cases reported each year has dropped from 31,000 cases to about 1,500 cases per year, according to the Centers for Disease Control and Prevention (CDC).

However, the hepatitis A vaccine is required for entrance to Kindergarten in only 13 states and Washington D.C.

One state that recently changed immunization requirements to include a mandatory hepatitis A vaccination for school aged children is Kentucky.

Kentucky has the highest number of hepatitis A cases amongst the ongoing outbreaks, with 1,788 cases and 14 deaths reported as of September 15, 2018. According to the latest Acute Hepatitis A Outbreak Report, over 75% of the cases reported in the outbreak have occurred in homeless people and/or PWID; however, more than 20% of the ill have become infected with hepatitis A without having any known risk factors.

The majority of cases in Kentucky have been reported in individuals between the ages of 30 and 39 years; less than 50 cases have been reported in individuals 0 to 19 years. Despite the low number of cases in juvenile populations, Kentucky schools have been faced with hepatitis A cases in students as well.

As part of the mandatory hepatitis A vaccination requirement, students had until September 8, 2018 to receive their vaccinations.

In 1 particular school in the state, Anderson County High School, a student fell ill with hepatitis A in late August, prior to the vaccination deadline. In response, the school sent home letters to parents of the students that may have been in contact with the student to warn of potential exposure. The school also performed a “deep clean,” as recommended by health officials.

Earlier in September, another school district in Kentucky, Elliot County, closed the school after a case of hepatitis A was confirmed. School activities were cancelled as a thorough clean of the school was conducted.

The cases occurring in individuals who are not considered high-risk pose a serious threat. Not only because of the asymptomatic nature of hepatitis A infections in children, but also because the virus seems to be transmitted from person-to-person in this outbreak.

While required vaccinations are a good start to keep young people safe, new regulations have also delayed education for some children in Kentucky schools. According to an article from Anderson County, dozens of students were unable to attend school due to non-compliance with the vaccination requirements, weeks after the deadline.

These outbreaks raise a very important question: Should hepatitis A vaccinations be mandatory for school aged children in every state to keep all children safe and in school?

Ohio among states battling sudden rise in hepatitis A cases

Thirty one cases have been reported in Ohio.

— The number of hepatitis A cases in Ohio and neighboring states has spiked since January, the Ohio Department of Health is reporting.

The are currently 31 cases in the state, the highest since 2015, the Greene County Public Health said in a release Tuesday. In comparison, there were four cases during the same period in 2017, two in 2016 and five in 2015, according to the release.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus, the agency said in the release. It is usually transmitted by person-to-person through contact with an infected person’s stool, or consumption of contaminated food or water, the release said.

“One thing you want to do is make sure your food is thoroughly cooked,” said Dan Suffoletto, public information supervisor at Public Health–Dayton & Montgomery County.

A confirmed case of hepatitis A includes both a positive laboratory test and symptom onset, with either jaundice or elevated liver function tests.

Outbreaks have been linked to contact with known hepatitis A case; homelessness; IV drug use; and men who have sex with men, the release said.

Ohio is the latest state to be affected by the Hepatitis A outbreak. Neighboring states such as Indiana, Kentucky and  Michigan have all been affected.

Health officials say people can be vaccinated to protect themselves from hepatitis A, but the two doses have to be taken over a six month period.

According to Greene County Public Health, hepatitis A contact can occur by:

• eating food made by an infected person who did not wash his or her hands after using the bathroom

• drinking untreated water or eating food washed in untreated water

• placing a finger or an object in your mouth that came into contact with an infected person’s stool

• having close personal contact with an infected person, such as through sex or caring for someone who is ill

One cannot get hepatitis A from:

• being coughed on or sneezed on by an infected person

• sitting next to an infected person

• hugging an infected person

A baby cannot get hepatitis A from breast milk.

What are the symptoms of hepatitis A:

Some people have symptoms two to six weeks after they come in contact with the virus.

People with hepatitis A typically get better without treatment after a few weeks. In some cases, symptoms can last up to six months.

These symptoms may include:

•dark yellow urine

•feeling tired


•gray- or clay-colored stools

•joint pain

•loss of appetite


•pain in the abdomen


•yellowish eyes and skin, called jaundice

Health officials warn against West Nile virus and Lyme disease

Erie County residents should protect against mosquitoes and ticks, especially at this time of year, the Erie County Health Department recommended Monday.

The West Nile virus has been identified through routine mosquito testing, and the risk of Lyme disease through ticks is heightened in September and October.

The West Nile virus is commonly found through routine testing in Erie County and this year is no exception. Most infected with the virus show no symptoms, but about one in five will develop a mild fever. County health officials recommend avoiding the outdoors at dusk and dawn and using insect repellent.

To avoid Lyme disease exposure, officials recommend keeping lawns mowed and cleared of garden litter, and walking on clear, marked trails. The ticks that carry the disease attach themselves to deer, which are more actively roaming this time of year.

Health officials combating hepatitis A outbreak in Whitley County

WILLIAMSBURG, Ky. (WYMT) –  A new report from the Cabinet of Health and Family Services shows an increasing number of hepatitis A cases in Kentucky. Whitley County is ranked fourth in the number of cases per county in the state. Workers at the Whitley County Health Department say they have seen this outbreak and are working hard to combat it.

“We have seen a lot of people come in and get vaccinated,” said Tamara Phelps, a nursing supervisor at the health department. “Especially our school children because it’s mandatory now and we have seen a lot of adults because they hear hepatitis A is in the community and they want to be protected.”

The report shows that Whitley County has 64 confirmed cases of hepatitis A. Jefferson County has the highest at 599 cases followed by Boyd County at 158 and Carter County at 121.

“We should start to see the numbers come back down,” said Martha Steele, the public health director for the county.

Steele said workers at the department have been doing all they can to help vaccinate people who are more at risk for the disease, in hopes of stopping the spread.

“They have vaccinated the people in the detention center, we’re working with them at the homeless shelter,” said Steele.

Workers at the health department said avoiding the outbreak is not hard to do. Simply getting vaccinated and washing your hands for more than 15 seconds with soap can stop the spread of the disease.


Wayne County Responds To Hepatitis A Outbreak

The number of hepatitis A cases in Wayne County, Indiana is among the highest in the country, and the response has been focused on vaccination and education.

Last week Wayne County recorded 97 cases of hepatitis A, a slight uptick from the previous week.  Health officials are optimistic the outbreak of the contagious liver infection may be under control.

Wayne County Health Department Executive Director Eric Coulter says state health department has assisted in the response effort.

“They were sending teams of staff to give immunizations for hepatitis A in high risk areas, like homeless populations, maybe missions,” says Coulter.

The county also offered shots at the county’s syringe exchange and to the incarcerated population. Nearly 2,000 vaccines have been administered since the outbreak began.

Wayne County Health Department Chief Operating Officer Kimberly Flannigan says improved awareness has helped.

“Some of the parents now, when they bring in their children for vaccines, they’re asking for this,” says Flannigan.

Clark County has the second highest number of cases in the state at 74.

Indiana has recorded 450 cases and one death.  Usually, the state has about 20 cases of hepatitis A in a year.

Illinois launches hepatitis A vaccination program amid outbreaks

SPRINGFIELD (Illinois News Network) — The state of Illinois is asking the people who are most at risk to get a hepatitis A vaccination amid outbreaks in neighboring states.

Indiana, Michigan and Kentucky are all dealing with hepatitis A outbreaks. Hundreds of people in each state are sick.

Illinois’ public health managers want to avoid the same. Last week the state launched a vaccination program.

Illinois Department of Public Health Director Nirav Shah said people who use intravenous drugs, or sleep with people who use drugs, have the highest risk of the highly contagious liver infection. That’s where the focus will be.

“We’ll be targeting the entire state,” Shah said. “But we’ll focus on the areas of the state that we know to have high numbers of people who have admitted drug use. Or high homeless populations.”

The Centers for Disease Control and Prevention is helping get hepatitis A vaccines to local health departments. Most of the shots will either be free or offered at a reduced price.

“The vaccine for Hep A…is extremely effective at preventing the disease,” Shah said. “Just one dose provides well over 90 percent protection, for over nine years.”

Shah said between January of last year and April of this year, the CDC confirmed more than 2,500 hepatitis A cases, many of them on Illinois’ borders.

Lexington Recommends All Residents Get Hepatitis A Vaccine

In the midst of a growing hepatitis A outbreak, health officials in Kentucky’s second-largest city are recommending all residents get vaccinated.

LEXINGTON, Ky. (AP) — Amid a growing hepatitis A outbreak, health officials in Kentucky‘s second-largest city are recommending all residents get vaccinated.

The Lexington-Fayette County Health Department announced the update Tuesday. It comes two months after health officials in Louisville made the same recommendation.

Officials say there have been 1,620 cases reported across 86 counties in Kentucky, with 12 cases in Lexington. A total of 13 deaths have been reported.

Officials say they have targeted the vaccine to high risk populations such as those who use illegal drugs and the homeless since the outbreak began. They say they now are recommending it for all residents of Fayette County.

Hepatitis A is transmitted by oral contact with fecal matter. It attacks the liver and causes symptoms including abdominal pain, nausea, diarrhea, fever and jaundice.