Hepatitis A Update

By Pam Millay, Director of Clinical Services

Hepatitis A is a highly contagious liver infection caused by a virus. When infected, the liver becomes inflamed or damaged and does not work properly. Although rare, death can occur from this infection. The Kentucky Department for Public Health declared a statewide outbreak of hepatitis A in November 2017, mainly among people who are homeless and/or using illicit drugs.

Hepatitis A usually spreads when a person ingests the virus from objects, food or drinks contaminated by small, unseen amounts of feces from an infected person. The virus also can be transmitted by close personal contact through sex or by caring for a person infected with hepatitis A. Symptoms of hepatitis A may include fatigue, fever, headache, diarrhea, nausea, dark urine, pale stool, jaundice (yellowing of the skin or eyes) and/or abdominal pain.

In early June, NKY Health initiated efforts to help stop the spread of hepatitis A from expanding in this region. NKY Health sent advisories to health care providers, correctional facilities, food service establishments, organizations that serve the homeless and substance use treatment providers.  These same groups also received information on hepatitis A, how to disinfect facilities, and hand washing posters to display in bathrooms.

The best ways to prevent the spread of hepatitis A include:

  • frequent and thorough hand washing with warm water and soap before preparing food, before eating and after using the restroom or changing diapers;
  • cleaning/sanitizing surfaces that are frequently touched (i.e., doorknobs, phones, etc.) with a bleach solution; and
  • receiving two shots of the hepatitis A vaccine six months apart.

Because we want to keep the numbers down in our region, we began planning and executing hepatitis A vaccination clinics in July to vaccinate those who are most at risk for contracting the disease. The groups we focused on included individuals (1) with substance use disorder, (2) who are homeless and (3) who are incarcerated.

When someone is exposed, we have 14 days from the time of first exposure to do Post-Exposure Prophylaxis (PEP) and prevent infection. Up until July, we primarily vaccinated groups that were exposed to hepatitis A as PEP, but in July we began vaccinating at-risk individuals prior to exposure. These vaccination clinics were held in community locations that served the at-risk populations and in the four county detention centers.

Since July, we have vaccinated 2,232 individuals:

  • 388 of those doses were provided as PEP
  • 1,476 of those doses were provided in the detention centers
  • 43 of those doses were provided at our SAEP programs
  • 284 of those doses were provided as part of clinic services
  • 429 doses were provided in various community locations

At this point, NKY Health is encouraging all adults in Northern Kentucky to get vaccinated even if they are not in an at-risk group. If enough individuals or a critical mass of individuals are vaccinated against hepatitis A, we can stop the spread of disease. It was an added requirement this year for all school-age children to have had both doses of the vaccine prior to starting school so that group is covered, as are younger children who receive the vaccine after turning one-year-old. Our work is to get as many adults vaccinated to stop the spread and end this outbreak.

As of Oct. 27, 2018, more than 2,410 cases have been reported in the Kentucky (compared to an average of 20 cases per year) with 16 deaths.

As of Nov. 5, 2018, Northern Kentucky has seen a total of 173 reported cases with 32 in Boone County, 43 in Campbell County, 36 in Grant County and 62 in Kenton County. There have been 108 individuals hospitalized and one death.