Kentucky has become the fifth state to declare an outbreak of hepatitis A, reporting the 31 cases so far this represent a 55 percent increase over the annual averages for the past 10 years.

California was the first to identify an outbreak, followed by Michigan, Colorado and Utah. Outbreak updates are inconsistent across the five states, but the most recent statistics as of Nov. 21 show 1,350 cases with 41 deaths. California reported 21 deaths as of this week and Michigan has reported 20.

Though Michigan officials are referring to the outbreak there as being in “Southeast Michigan,” there are confirmed cases in other parts of the state. Most of the California cases, 553 out of 649, are in San Diego.

In Kentucky, 31 cases of acute hepatitis A, defined partially by the rapid onset of symptoms, had been confirmed as of Tuesday. Of those, 19 are in Jefferson County, which includes Louisville, KY, making it the most populated and most urban county in the state. The state usually records an average of 20 cases annually, according to a health alert from the Kentucky Department of Public Health.

“… laboratory specimens from recently diagnosed cases have been sent for specialized genetic testing of the hepatitis A virus at the Centers of Disease Control and Prevention in Atlanta,” according to the Kentucky alert.

“Thus far test results match the genotype associated with an acute Hepatitis A outbreaks in California.”

Vaccination efforts
As in California, Michigan and other states, health officials in Kentucky are working to vaccinate adults, focusing on homeless people and substance abusers. Since its approval in recent years, most children have received the hepatitis A vaccine as part of standard preventive care, so adults are generally considered at higher risk of contracting the infection.

In California about two-thirds of confirmed victims are substance abusers and/or homeless. In Michigan about three-fourths of confirmed cases fall into those categories. The remaining cases in both states and a number of victims on other outbreak states are neither homeless nor substance abusers.

San Diego County alone has administered more than 100,000 doses of hepatitis A vaccine in California. For at least three months, health officials there have been strategically scheduling vaccination efforts in areas with large numbers of homeless people to reach those most at risk of contracting the viral infection.

A similar plan is in the works in Kentucky, according to state Epidemiologist Dr. Jonathan Ballard of the Department of Public Health (DPH).

“DPH is working with the Louisville Metro Department of Public Health and Wellness and other local health departments to develop an emergency vaccine distribution plan for the area most impacted by the outbreak,” Ballard said in the Kentucky health alert.

In addition, DPH is activating the State Health Operations Center to Level 3 status to help coordinate the public health response in Kentucky.

CDC says vaccine supplies ‘constrained’
Federal officials have been working with state and local health departments for several months to address the need for the hepatitis A vaccine. Local media outlets in several parts of the country have reported that public health officials are struggling to secure enough of the vaccine to meet needs.

The Centers of Disease Control and Prevention has included updates on its vaccine supply website, posting “notes” in mid-October and Wednesday this week. Both notes state that demand for the hepatitis A vaccine for adults has “increased substantially over the past six months.”

The two CDC vaccine supply notes are virtually identical, citing efforts by the federal agency to work with states to “provide guidance about how best to target vaccine distribution.”

“In addition, U.S.-licensed manufacturers of adult hepatitis A vaccine are exploring options to increase domestic supply and are working collaboratively with CDC to monitor and manage public and private vaccine orders to make the best use supplies,” according to the CDC vaccine supply update this week. “Of note, the constraints described in this footnote do not apply to the pediatric hepatitis A vaccine supply in the U.S.”

Advice to the public
Other than vaccination, the best way to keep from contracting hepatitis A infection is to wash your hands using warm water and soap, to handle uncooked food appropriately and to fully cook food, according to the Kentucky health alert.

“Always wash your hands before touching or eating food, after using the toilet and after changing a diaper. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers,” Kentucky officials recommend, echoing advice offered in recent months by federal, state and local officials across the country.

“The virus is found in the stool of people infected with hepatitis A and is usually spread from person to person by putting something in the mouth, even though it might look clean, that has been contaminated with the stool of a person infected with hepatitis A.”

Anyone with symptoms of hepatitis A should seek medical attention. Anyone who has had close contact with someone infected with the virus should also seek medical attention to determine if they should receive the post-exposure vaccine.

Signs and symptoms of hepatitis A include yellowing of the skin or eyes, dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea and fever.

Not everyone with the acute hepatitis A virus infection will develop symptoms, however, if symptoms do develop, they may include fever, jaundice or yellowing of the skin, vomiting, fatigue, and grey-colored stools.  Persons with symptoms should seek medical care for prompt diagnosis and treatment.

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