On November 28 the Kentucky Department for Public Health declared an outbreak of acute Hepatitis A (HAV) with cases in multiple counties in Kentucky. The overwhelming majority of the cases have been in Louisville, primarily among the homeless, and people who use drugs. Louisville’s Department of Health and Wellness confirms the hepatitis outbreak in Jefferson County has reached 115 cases since November.
The following Information is from Louisville’s Department of Health and Wellness:
What is Hepatitis?
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause Hepatitis but a virus often causes Hepatitis. In the United States, the most common hepatitis viruses are Hepatitis A virus, Hepatitis B virus, and Hepatitis C virus.
What is Hepatitis A?
Hepatitis A is a highly contagious liver infection caused by the Hepatitis A virus. It can range from 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.
How is Hepatitis A spread?
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. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.
Who is most at risk for Hepatitis A?
Although anyone can get Hepatitis A, in the United States, certain groups of people have a higher risk:
People who are homeless
People who use drugs (injection or non-injection)
Men who have sexual contact with men
People with direct contact with someone who has Hepatitis A
Travelers to countries where Hepatitis A is common
Household members or caregivers of a recent adoptee from countries where Hepatitis A is common
People with clotting factor disorders, such as hemophilia
People working with nonhuman primates
If you are in one of these high risk groups, please call us at 502-574-6675 to ask about being vaccinated against Hepatitis A. Hepatitis A is a vaccine preventable disease.
Recommendations for Providers during the Current Hepatitis A Outbreak
General information on Hepatitis A for providers can be found here.
1. Consider HAV infection in individuals, especially the homeless, people who use drugs and MSMs (Men who have Sex with Men) with discrete onset of symptoms (e.g., nausea, vomiting, diarrhea, anorexia, fever, malaise, dark urine, light-colored stool, or abdominal pain), and jaundice or elevated liver function tests.
2. Complete the HAV Risk Questionnaire on all suspect cases and report all confirmed cases with 24 hours. Please complete the HAV Risk Questionnaire found here on all suspected cases and fax it to the Louisville Metro Department of Public Health and Wellness at 502-574-5865.
Providers should also report all lab confirmed HAV cases within 24 hours to the Louisville Metro Department of Public Health and Wellness by fax at 502-574-5865 or by phone at 502-574-6675. Please use the EPID200 form found here. This is required reporting and is not a violation of HIPAA.
3. Provide post-exposure prophylaxis (PEP) for close contacts of confirmed HAV cases. Susceptible people exposed to hepatitis A virus (HAV) should receive a dose of single-antigen HAV vaccine or intramuscular (IM) immune globulin (IG) (0.1 mL/kg), or both, as soon as possible within 2 weeks of last exposure. The efficacy of combined HAV/Hepatitis B virus (HBV) vaccine for PEP has not been evaluated, so it is not recommended for PEP. Providers who do not have available vaccine may direct patients to the Louisville Metro Department of Public Health and Wellness at 400 E. Gray St.
4. Provide HAV vaccine to the homeless, people who use drugs and MSMs (Men who have Sex with Men) who are not already immunized. The combined HAV/HBV vaccine may be used in this group if the individual is not already immune to HBV.
5. Provide HAV vaccine to unimmunized school age children. Effective July 1, 2018 all Kentucky students in kindergarten through twelfth grade must show proof of having received two doses of Hepatitis A vaccine to attend school. Providers should begin providing these immunizations to their patients.