Public Health And Wellness Continues To Respond To Hepatitis A Outbreak

Photo: Louisville Metro Public Health And Wellness

The Louisville Metro Department of Public Health and Wellness continues to work to control an outbreak of acute hepatitis A that has centered in the city’s homeless and among those who use illicit drugs.

On November 21, 2017 the Kentucky Department for Public Health declared an outbreak of acute hepatitis A in several counties throughout the state.  To date there have been 142 cases in Kentucky of which 124 have occurred Louisville.  Today, the Kentucky Department of Public Health announced the death of a Jefferson County resident with multiple other health issues whose symptoms and lab results met the case definition of acute hepatitis A infection.  This is the first death in Kentucky associated with this outbreak.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by a virus. It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Most adults with hepatitis A symptoms may experience fatigue, low appetite, stomach pain, nausea, or jaundice, that usually resolve within 2 months of infection; most children less than 6 years of age do not have symptoms or have an unrecognized infection. Antibodies produced in response to hepatitis A infection last for life and protect against reinfection. The best way to prevent hepatitis A infection is to get vaccinated.

Since the outbreak was declared in 2017, the Louisville Metro Department of Public Health and Wellness has activated its Incident Command System to coordinate its response to control the outbreak. The department has given nearly 6,000 hepatitis A immunizations at homeless shelters, homeless camps, recovery houses and at agencies such as Family Health Centers’ Phoenix Health Center. It has also provided immunizations at Metro Corrections, both at intake and in the general population. It regularly continues to provide immunizations at its syringe exchange sites, its Specialty Clinic and at the MORE Center.

In addition, the U of L pharmacy has provided immunizations for first responders at agencies such as EMS, Public Works and Louisville Fire.  The Department of Public Health and Wellness is also working with Kroger Little Clinics and Walgreen’s to immunize other first responders.  The Centers for Disease Control and Prevention (CDC) has praised Louisville’s response to the hepatitis A outbreak calling it the “gold standard” and a model for other cities to emulate.

“The best way to prevent hepatitis A is to get immunized,” said Dr. Lori Caloia, medical director of the Department of Public Health and Wellness.  “Certainly those who have hepatitis B or C or who have other types of liver disease should get immunized,” she said. “Among these people hepatitis A can be fatal.”

“Almost everyone knows someone who uses drugs.  People who use drugs should be encouraged to get immunized.  Those who are homeless and those who work with the homeless should also get vaccinated,” said Dr. Caloia.  “Anyone who wants to avoid getting hepatitis A should consult their health care provider to see if a hepatitis A immunization is right for them,” said Dr. Caloia.

To control the outbreak the Department of Public Health and Wellness is working with the Centers for Disease Control and Prevention to give free hepatitis A vaccinations to the homeless, those who work with the homeless and those who use illicit drugs.  These groups can get free immunizations at the following times and locations.

• Louisville Metro Syringe Exchange
  400 E. Gray St.
  Mondays & Fridays 11am – 4pm
  Tuesday & Wednesday 1pm – 6pm
  Thursday 3pm – 6pm
  Saturday 11am – 2pm
• Family Health Center – Phoenix
  712 E. Muhammad Ali Blvd.
  Monday – Friday
  8am – 4:30 pm

All others wishing hepatitis A vaccination should contact their healthcare provider or contact their local Kroger Little Clinic or Walgreen’s.

The Centers for Disease Control and Prevention recommends hepatitis A vaccination as follows:

• All children at age 1 year,
• Persons who are at increased risk for infection,
• Persons who are at increased risk for complications from hepatitis A, and
• Any person wishing to obtain immunity (protection).

Kentucky also now requires all schoolchildren in kindergarten through twelfth grade to get two doses of hepatitis A vaccine.

While the current hepatitis A outbreak in Louisville has centered in the homeless and those who use illicit drugs, the CDC also lists these groups as being at increased risk for hepatitis A.

Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A. Persons who travel to developing countries are at high risk for hepatitis A, even those traveling to urban areas, staying in luxury hotels, and those who report maintaining good hand hygiene and being careful about what they drink and eat (see https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/hepatitis-a for more information).

Men who have sex with men. Men who have sex with men should be vaccinated.

Users of injection and non-injection drugs. Persons who use injection and non-injection drugs should be vaccinated.

Persons who have occupational risk for infection. Persons who work with HAV-infected primates or with HAV in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for HAV infection because of occupational exposure.

Persons who have chronic liver disease. Persons with chronic liver disease who have never had hepatitis A should be vaccinated, as they have a higher likelihood of having fulminant hepatitis A (i.e., rapid onset of liver failure, often leading to death). Persons who are either awaiting or have received liver transplants also should be vaccinated.

Persons who have clotting-factor disorders. Persons who have never had hepatitis A and who are administered clotting-factor concentrates, especially solvent detergent-treated preparations, should be vaccinated.

Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.  Previously unvaccinated persons who anticipate close personal contact (e.g., household contact or regular babysitting) with an international adoptee from a country of high or intermediate endemicity during the first 60 days following arrival of the adoptee in the United States should be vaccinated. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee. More information is available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a4.htm.

Persons with direct contact with persons who have hepatitis A. Persons who have been recently exposed to HAV and who have not previously received hepatitis A vaccine should be vaccinated.  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm

Other than vaccination, the best way to keep from getting hepatitis A is to wash your hands using warm water and soap, to handle uncooked food appropriately, and to fully cook food. Always wash your hands before touching or eating food, after using the toilet, and after changing a diaper.