Confirmed cases of hepatitis A continue to increase this week in a multi-state outbreak, prompting California officials to extend an emergency declaration while Michigan officials are urging restaurant workers and customers to seek vaccinations.

Employees at two more restaurants in Michigan have been found to have worked while infected with the highly contagious virus. Post-exposure treatment — which must be given within two weeks of exposure to the virus — can still be administered to people who consumed food or beverages at the two pizza restaurants in November.

The Detroit Health Department is investigating a case at Paul’s Pizza on West Vernor and urges vaccinations by Friday for anyone who dined at the restaurant between Nov. 20 and Nov. 25.

The Oakland County (MI) Health Division has confirmed a case at Papa Romano’s pizzeria on Nine Mile at Telegraph Road and is urging vaccinations by Sunday for anyone who dined there between Nov. 22 and Nov. 26.

As of the most recent update on Nov. 29, public health officials in Michigan had confirmed 555 cases of hepatitis A in the ongoing outbreak, with 140 cases in Detroit. Oakland County has 82 reported cases. Statewide, 20 outbreak victims have died. More than 80 percent of the Michigan victims have required hospitalization.

Michigan officials have mounted a campaign to encourage all foodservice workers in the state to get the hepatitis A vaccine. The Michigan Department of Agriculture and Rural Development sent a letter to all licensed foodservice facilities reminding operators of the effects of hepatitis A, how it is transmitted and how it can be prevented.

People with health insurance coverage are urged to seek vaccinations through their doctors or pharmacies. For others, state health department will be providing immunization to all foodservice workers who have not previously been vaccinated for hepatitis A.

The free clinics are scheduled for Monday, Tuesday, Thursday and Friday from 8:30 a.m. to 11:30 a.m. and 1 p.m. to – 4:30 p.m. On Wednesday the clinics are scheduled from 10 a.m. to 11:30 a.m. and 1:30 p.m. to 6:30 p.m. The clinics will be on a walk-in basis through December 15.

California county opts for caution
San Diego County officials this week extended the emergency status they imposed Sept. 1 related to the outbreak there, citing the situation in Michigan as part of their rationale.

“We don’t want a resurgence like they’re having in Detroit, so we need to continue this emergency,” County Board Chairwoman Dianne Jacob said during the board’s Tuesday meeting. The vote to extend the emergency status was unanimous.

As of Tuesday, San Diego County reported 567 confirmed cases, with 20 deaths. About 100 cases have been confirmed elsewhere in the state, with one death in Santa Cruz, according to the California Department of Public Health.

In California and Michigan the majority of confirmed hepatitis A cases have been among homeless people and substance abusers. However, from 25 percent to 34 percent of victims in those states are neither homeless nor substance abusers.

Public health nurses and others have administered more than 109,000 vaccinations in California.

Other state updates
Utah is third behind California and Michigan in terms of confirmed cases, with the most recent update from the Utah Department of Health reporting 87  people confirmed infected by the outbreak strain of hepatitis A. State officials said Utah usually has three or four confirmed cases per year.

In Colorado, the confirmed case count stood at 62 people as of Dec. 1. Neither Utah nor Colorado have any confirmed deaths in the outbreak.

Nevada, Arizona and Kentucky have also reported people infected with the outbreak strain.

In Kentucky, public school students of all ages will be required to have hepatitis A vaccinations before the beginning of the 2018-19 school year. The Kentucky legislature approved the immunization requirement in June, well before the state’s health officials declared outbreak status in recent days.

Vaccine shortage
The outbreak and subsequent vaccination efforts have resulted in what federal officials describe as “supply constraints for hepatitis A vaccine” nationwide. The Centers for Disease Control and Prevention reported the supply problems in mid-October and has not substantially updated the information since then.

“Currently, the supply constraints for adult Hepatitis A vaccine in the United States are nationwide, meaning that all providers are likely affected,” a CDC spokesman told Food Safety News Tuesday.

“While CDC and state/local public health officials are targeting vaccine to manage outbreaks and carry on routine vaccination, current supply is not sufficient to support the full level of demand for vaccine.”

According to the CDC’s vaccine supply website, the shortage is being addressed with the following actions:

  • CDC staff are working directly with public health officials to provide guidance about how best to target vaccine distribution.
  • CDC is working with the manufacturers of adult Hepatitis A vaccines to monitor and manage public and private vaccine orders to make the best use supplies of adult Hepatitis A vaccine during this period of unexpected increased demand.
  • In addition, manufacturers are exploring options to increase domestic adult Hepatitis A vaccine supply. One manufacturer has made additional doses of adult Hepatitis A vaccine available on the CDC vaccine purchase contracts to help in the management of ongoing outbreaks in several U.S. cities and states. This additional vaccine also provides for a public sector reserve for future outbreaks during this time of constrained supply.

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 public health officials at all levels.

People should always wash their hands before touching or eating food, after using the toilet and after changing diapers. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers should be used.

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. It can take up to 50 days after exposure for symptoms to develop.

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. People with symptoms should seek medical care for prompt diagnosis and treatment.

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