‍Quick reactions to even one infected food service worker have helped the Marion County Public Health District in Indianapolis keep Hepatitis A cases at bay.

That’s what Marion County Public Health was up to earlier this week when it conducted an all-day clinic Monday for anyone who might have come in contact with a staff member at the Burger King, located at 3311 South Kentucky Avenue in Indianapolis who was diagnosed with hepatitis A.  

Anyone who at that Burger King, near Mann Road, between Jan. 21 and 24 is at risk for the highly contagious liver infection. Marion County Public Health offered the clinic for anyone needing post-exposure Hepatitis A vaccinations, which must be given within two weeks of exposure to be effective against the virus.

The Burger King outlet was subjected to additional cleaning after it was determined an employee was infected, but was permitted to remain open during the cleaning process.

Indianapolis finds itself almost in the dead center of 11 adjoining states that have, since early 2017, documented hepatitis A outbreaks. The virus is often spread through person-to-person contact, but also can be transmitted in foods and beverages that have been contaminated by infected people. Indianapolis has managed not to dominate the outbreak scene in the way that the nearby metro areas of Detroit and Louisville have. 

The federal Centers for Disease Control and Prevention’s Division of Viral Hepatitis (DVH) finds homelessness and injection drug use as common factors contributing to the rise in Hepatitis A cases. In some outbreak states, though, up to a third of those with confirmed  infections have not been in either of those high-risk groups

Fast response, like that which occurred this week, has helped Marion County Public Health kept its contribution to the outbreak limited. As of Feb. 1, Indiana has recorded 959 Hepatitis A cases. Only 78 of those patients have been Indianapolis residents. Hepatitis A has sent 480 Hoosiers to area hospitals and resulted in two deaths.

Prior to this week’a vaccination clinic, Marion County Public Health had vaccinated 8,823 residents for Hepatitis A. Statewide, 114,243 people have been vaccinated for the virus.

Not only does Indianapolis not stand out in the region, Marion County, with almost almost 1  million people, has had only half the Hepatitis A cases as Wayne County, which has just more than 100,000 residents.

During the same period — from mid 2017 through early 2019 — the half dozen states bordering or near Indiana have collectively reported nearly 9,000 Hepatitis A cases, resulting in 70 deaths. About half of those infected required hospitalization. Those states include Illinois, Michigan, Kentucky, Illinois, Ohio and West Virginia.

Here are CDC’s responses to some common questions about the recent Hepatitis A outbreaks around the country:

Who should be vaccinated against hepatitis A in places where there is no ongoing HAV outbreak?

The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis A vaccination for the following people:

  • All children at age 1 year
  • Travelers to countries where hepatitis A is common
  • Family and caregivers of adoptees from countries where hepatitis A is common
  • Men who have sexual encounters with other men
  • Users of injection and non-injection drugs
  • People with chronic liver disease
  • People with clotting-factor disorders
  • People who work with HAV-infected primates or with HAV in research laboratory settings
  • People with direct contact with others who have hepatitis A
  • Any people wishing to obtain protection from infection in the future

Are the number of hospitalizations and deaths associated with the outbreaks among people who use drugs and people who are homeless higher than usual? Why?

The numbers of hospitalizations and deaths during these hepatitis A outbreaks have been higher than what is normally reported through national surveillance of hepatitis A. While routine childhood hepatitis A vaccination practices since 1996 have provided higher immunity in younger populations, many adults remain susceptible. Hepatitis A often results in severe disease among older people who are not immune from previous vaccination or community-acquired infection. Higher than expected hospitalization rates have been noted in the past among people with pre-existing chronic illnesses such as diabetes, chronic liver disease, or cirrhosis. Fulminant liver failure and death from hepatitis A infection are both rare, but are more common in older people when infected.

Are the outbreaks among people who use drugs and/or people who are homeless spreading because of contaminated foods, drinks, or infected food handlers?

No. In these outbreaks, the virus is being spread from person-to-person primarily among people who use injection and non-injection drugs, people who are homeless, and their close direct contacts. Although cases in food handlers occur, common sources of food or drinks have not been identified as potential sources of infection in the jurisdictions experiencing hepatitis A outbreaks.

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using illicit drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation.

During the ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who are in high-risk groups are at greater risk for HAV infection.

What should I do if I have eaten at a restaurant that has reportedly had a hepatitis A-infected food handler?

If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. They should be able to help you determine whether you were recently exposed to hepatitis A virus at a specific restaurant; whether you previously had the vaccine; and whether you might benefit from an injection of either immune globulin or hepatitis A vaccine if you have been exposed. However, the post-exposure vaccines and immune globulin treatment are only effective if given within two weeks after exposure. A health professional can decide what is best based on your age, overall health, and other factors.

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