Responding to a request from Gov. Jim Justice, the federal Centers for Disease Control and Prevention has moved a 6-person team into West Virginia to help knock down an outbreak of Hepatitis A.
Gov. Justice asked for federal help as West Virginia’s Hepatitis A count reached 975, including 513 cases in the state capital of Charleston and the surrounding Kanawha County. West Virginia is one of several states reporting significant increases in Hepatitis A infections, and the first to get CDC “boots-on-the-ground.”
In June, the Atlanta-based agency reported more than 2,500 cases of Hepatitis A infections associated with person-to-person transmission in multiple states between January 2017 and April 2018.
According to CDC, Hepatitis A infection is a vaccine-preventable illness. The primary means of hepatitis A virus (HAV) transmission in the United States is typically person-to-person through the fecal-oral route (i.e., ingestion of something contaminated with the feces of an infected person).
Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Although rare, atypical extrahepatic manifestations include rash, pancreatitis, renal disease, arthritis, and anemia. Severe infections can result in cholestatic hepatitis, relapsing hepatitis, and fulminant hepatitis leading to death.
Average incubation of HAV is 28 days, but illness can occur up to 50 days after exposure. An HAV-infected person can be viremic up to six weeks through their clinical course and excrete virus in stool for up to two weeks before becoming symptomatic, making identifying exposures particularly difficult. Illness from hepatitis A is typically acute and self-limited; however, when this disease affects populations with already poor health (e.g., hepatitis B and C infections, chronic liver disease), the infection can lead to serious outcomes, including death.
Dr. Rahul Gupta, West Virginia’s chief health officer, said CDC personnel are in the state for epidemiological support, data quality, and case investigation strategies. Gupta says the CDC personnel are “world-class experts.”
The six epidemiologists are from CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention. They will be in West Virginia for two to four weeks, working out of the Kanawha-Charleston Health Department on data management and case investigation strategies.
West Virginia’s 975 new Hepatitis A cases were recorded from March to August in 27 of the state’s 55 counties, and the state’s outbreak has included two deaths. People who are drug users or homeless or both are among those most at risk.
Asking for federal help is not West Virginia’s only changing strategy for combating the outbreak. It has spent $769,000 on 18,270 does of Hepatitis A vaccine. The number of new cases peaked at 110 during the first week of July. The number of new cases has decreased since then.
The state is no longer naming as many restaurants for just being involved in the outbreak by their employment of food workers infected with Hepatitis A. Only when food handling procedures suggest the public might be at risk are restaurants named. That change came after the state found not a single Kanawha County Hepatitis A case involves transmission from a restaurant worker.
CDC in June said injection and non-injection drug use and homelessness were top risk factors among national Hepatitis A cases. At that time it suggested increased adequate vaccine supply would be necessary to control the outbreak.
“Person-to-person transmission of HAV between persons who report drug use and/or homelessness could result from contaminated needles and other injection paraphernalia, specific sexual contact, and practices, or from generally poor sanitary conditions,” the June report said.
“Transience, economic instability, limited access to health care, distrust of public officials and public messages, and frequent lack of follow-up contact information makes this population difficult to reach for preventive services such as vaccination, use of sterile injection equipment, and case management and contact tracing. These challenges make outbreaks among these groups difficult to control.”
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