Hepatitis A Outbreak in West Virginia Leaves Officials Scrambling

West Virginia’s Bureau for Public Health has requested the assistance from the CDC to contain the statewide hepatitis A outbreak.

Case counts in multiple outbreaks of hepatitis A continue to grow, as health officials organize mass vaccination campaigns to prevent infections in those at risk. However, health officials in some states are having more difficulty than others in keeping outbreaks contained.

The West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health (BPH) has requested the assistance from the US Centers for Disease Control and Prevention to help control the outbreak in their state. Viral sequencing has linked the strain to the outbreaks in Kentucky and California.

As of August 24, 2018, there have been 1031 reported cases in West Virginia. The ill range in age from 12 to 82 years with a median age of 37 years; 59.8% of the those who have fallen ill are men. There have been 562 hospitalizations (54.5% of total cases) and 2 deaths reported thus far.

The majority of cases in the state have occurred in Kanawha County (534 cases) and Putnam County (83 cases).

The increase in cases have been seen mostly among high-risk individuals including drug users, homeless individuals, and recently incarcerated populations, according to the BPH. Of the 1031 confirmed cases, 126 or 12.2% of the ill are homeless. Additionally, of the 858 of the ill who provided data pertaining to drug use, 666 individuals or 77.6% reported using illicit drugs.

According to an article published in the Scientific American, self-reported data from hepatitis A patients indicate that 58% of drug users inject drugs and 42% use non-injectable drugs; some report using both.

As part of their outbreak response effort, the BPH has provided 18,270 doses of hepatitis A vaccine statewide and has issued press releases and health advisories for health care providers in the state.

The guidelines encourage health care providers to report any and all confirmed and suspected cases of hepatitis A, to screen patients who are at increased risk of infection, such as those who use drugs, men who have sexual contact with men, individuals who are currently or were recently incarcerated, and or homeless or highly mobile individuals. Health officials also call for special attention to individuals with elevated liver function and/or jaundice. If a patient presents with any symptoms of hepatitis A, a complete hepatitis panel should be ordered.

The BPH is providing vaccinations for all of the populations indicated above as well as their contacts and food service workers.

In addition to concern among high-risk populations there is a concern that hepatitis A could be transmitted through consuming contaminated food.

On August 16, 2018, the Kanawha-Charleston Health Department—where the majority of the cases in West Virginia have been reported—released a health advisory to residents of the county who ate at restaurant where food was prepared by an individual who has been diagnosed with hepatitis A. The health officials advised all patrons who visited the restaurant and consumed any products to receive a vaccination.

While there are concerns over the possibility of hepatitis A transmission from food service workers to restaurant patrons, there have been no confirmed cases of this occurrence in this outbreak.

West Virginia health officials are not the only state officials worried about the possibility of transmission from contaminated food served by food service workers who have been infected with hepatitis A.

Meanwhile, as of August 24, 2018, the state of Arkansas has declared a hepatitis A outbreak with a total of 100 cases reported since February. The outbreak is primarily a concern in Northeast Arkansas in both Greene and Clay County where the majority of the cases have been reported. A representative for the Arkansas Department of Health told Contagion®, "over half of our cases have been reported in illicit drug users. Around 30% have been co-infected with [hepatitis] C. Over 90% have been Caucasian and 70% have been male."

The Arkansas Department of Health has issued multiple news releases warning patrons who ate at restaurants where an employee has been diagnosed with hepatitis A. The 2 popular chain restaurants that were included in the warnings were Little Caesar’s Pizza and Red Lobster.

The Department of Health representative told Contagion®, “We have not been able to confirm transmission via contaminated food in restaurants. The announcements have been precautionary.”

In areas where outbreaks are occurring, the CDC advises that health care providers work with health officials and community partners to provide vaccines to high risk populations especially injection and non-injection drug users. Vaccines should also be considered for anyone in close contact with high-risk individuals.

To stay up-to-date on the number of confirmed cases of hepatitis A in all outbreaks, be sure to check out the Contagion® Outbreak Monitor.

Updated: 8/29/18 at 1:25 PM to reflect additional information from the Arkansas Department of Health.