PUBLIC HEALTH
MULTI-STATE OUTBREAK STATISTICS*
State Onset Cases Hospitalization
Rates Deaths
Michigan
Utah
California**
Kentucky***
Indiana
Missouri
Tennessee
Ohio
Arkansas
West Virginia
North Carolina
Massachusetts 8/2016
1/2017
4/2017
11/2017
11/2017
9/2017
12/2017
1/2018
2/2018
3/2018
1/2018
4/2018 907
281
704
2769
698
231
491
971
200
1963
43
188 728 (80.3%)
152 (56%)
461 (65%)
1438 (52%)
320 (46%)
96 (41.6%)
302 (62%)
Not available
Not available
1010 (51.5%)
32 (74%)
(87%) 28 (3.1%)
2
21 (3%)
17 (.006%)
2
0
1
1
Not available
5
1
4
*Data collected 11/30/2018 from CDC and may be outdated https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm
**California outbreak declared over 4/11/2018
*** Kentucky outbreak information can be obtained at the Kentucky Cabinet for Health and Family Services webpage: https://chfs.ky.gov/agencies/dph/dehp/idb/
Pages/Hepatitis%20A%20Outbreak.aspx
(continued from page 7)
In fact, because of the multi-state outbreak statistics, the Advisory
Committee on Immunization Practices (ACIP) has recently recom-
mended that all homeless individuals receive hepatitis A vaccination
(https://www.aafp.org/news/health-of-the-public/20181031acip-
meeting.html) 1 Individuals with unstable housing, those who use
illicit drugs, and those who have been recently incarcerated or are
in recovery centers are often highly mobile, moving to where they
can access homeless services or obtain employment.
These individuals coming to Jefferson County from surrounding
counties with high hepatitis A rates could easily bring the infection
back to Jefferson County and cause our caseload to rise again. We
need to continue to vaccinate to keep our immunity rates high in
our area.
Some have asked why the outbreak patients seem so sick. Many
patients have been homeless, and their baseline health status was
not ideal before hepatitis A virus infection. Many patients are co-in-
fected with hepatitis B or C. Those age 20 through 60 seem to be at
highest risk, and adults tend to have worse outcomes than children.
Adults have a more robust immune response to the virus and thus
have more severe outcomes. These factors account for the high
hospitalization and death rates seen in the multi-state outbreaks.
For those interested in learning more about the multi-state
outbreaks, an updated chart is listed above, and a Morbidity and
Mortality Weekly was released November 2, 2018 describing 2017
outbreaks (https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/
mm6743a3-H.pdf). 2
Remember that continued vaccination, in addition to early di-
agnosis of hepatitis A virus with hepatitis A IgM antibody, elevated
transaminase levels, and symptoms of viral hepatitis and prompt
reporting to the Louisville Metro Department of Public Health and
Wellness Communicable Disease staff are all essential to continue
to keep this outbreak under control! Please fax new case reports
to (502) 574-5865.
Thanks for your continued efforts to control the hepatitis A
outbreak.
Lori Caloia is the Medical Director Louisville Metro Department of Public
Health and Wellness
References:
1. Center for Disease Control and Prevention. 2017 – Outbreaks of hepatitis
A in multiple states among people who use drugs and/or people who
are homelesshttps://www.cdc.gov/hepatitis/outbreaks/2017March-Hep-
atitisA.htm
2. Crawford, Chris. ACIP Recommends Hep A Vaccine for Homeless
Patients. Accessed 11/30/2018 from: https://www.aafp.org/news/
health-of-the-public/20181031acipmeeting.html
3. Foster, M; Ramachandran, S; Myatt, K, et al. Hepatitis A Virus Outbreaks
Associated with Drug Use and Homelessness — California, Kentucky,
Michigan, and Utah, 2017. MMWR Morb. Mortal Wkly. Rep 2018;67:
1208-1210. Accessed 11/30/2018 from: https://www.cdc.gov/mmwr/
volumes/67/wr/pdfs/mm6743a3-H.pdf0
FEBRUARY 2019
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