West Virginia is experiencing a Hepatitis A outbreak, which is linked to a multi-state outbreak. As of May 21, 2018 there has been 106 confirmed cases reported in 8 counties in West Virginia. This increase in confirmed cases of acute hepatitis A virus has been primarily among:
- IV and non-IV drug users
- Homeless or highly mobile individuals
- Recently incarcerated individuals
In early May the Wheeling-Ohio County Health Department began vaccinating the homeless population through the department’s Project HOPE program. At this time there are no local cases of hepatitis A in the county or region linked to this outbreak.
CDC does not recommend the vaccination of food service employees for hepatitis A, they are not considered at an increased risk for the virus because of their occupation. However, because of the high incidence of injection and non-injection drug use reported in West Virginia and among the food service industry, the West Virginia Bureau for Public Health recommends all food service employees in Kanawha and Putnam counties be vaccinated.
At this time, the Wheeling-Ohio County Health Department is not recommending or requiring (through Board of Health action) the vaccination of our food service workers. This could change with an increase in local cases.
The department is, however, encouraging employees in the food service industry to get vaccinated. This can be done individually through an employee’s healthcare provider or pharmacy. The health department can also assist with these vaccinations (either individually or for a business) through the department’s Adult Vaccination Clinic. Cost of the vaccine is $59.25 per dose (two dose series) plus a $30.00 administration fee. Some insurances may cover the cost of this vaccination.
Hepatitis A as a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people. Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person.
People at higher risk of getting hepatitis A are:
- People with direct contact with someone who has hepatitis A
- Travelers to countries where hepatitis A is common
- Men who have sexual contact with men
- People who use drugs, both injection and non-injection drugs
- Household members or caregivers of a recent adoptee from countries where hepatitis A is common
- People with clotting factor disorders, such as hemophilia
- People working with nonhuman primates
Children under 6 who get hepatitis A often have mild or no symptoms. Many children may be immune, because children have been routinely vaccinated for hepatitis A since 2006 and in West Virginia, the vaccine is required for prekindergarten attendance, but is not required at entry to public school.(3) Parents should review their children’s immunization records to see if they have been immunized. Older Children and Adults who have not had the disease in childhood or been vaccinated can get sick and typically have symptoms which start an average of 4 weeks, but can occur between 2 and 7 weeks after exposure. Symptoms may include:
- Loss of appetite
- Abdominal pain
- Dark urine
- Clay-colored stools
- Joint pain
- Jaundice (yellowing of the skin and eyes)
According to the CDC, the best way to prevent hepatitis A is through vaccination with the hepatitis A vaccine. To get the full benefit of the hepatitis A vaccine, more than one shot is needed. The number and timing of these shots depends on the type of vaccine you are given. Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food – plays an important role in preventing the spread of hepatitis A. 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 recreational drugs, whether injected or not
- People with chronic or long-term liver disease, including hepatitis B or hepatitis C
- People with clotting-factor disorders
- People with direct contact with others who have hepatitis A
- Any person wishing to obtain immunity (protection)
The West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health has requested the Kanawha-Charleston Health Department (KCHD) provide hepatitis A vaccination clinics for restaurant and food service employees in Kanawha and Putnam counties as part of the response to the national outbreak. Most of the cases in this outbreak have occurred in Kanawha and Putnam counties.
“I am issuing a strong recommendation to all Kanawha and Putnam County food service vendors and restaurants to have their employees vaccinated for hepatitis A, since national data indicate that drug use among the food service industry is about 19.1 percent,” said Dr. Rahul Gupta, State Health Officer and Commissioner of DHHR’s Bureau for Public Health. “Because of the high incidence of drug use reported in West Virginia and among the food industry, this is a proactive measure to vaccinate a high-risk group in accordance with the Centers for Disease Control and Prevention (CDC) guidelines. We strongly advise that all food service owners take this recommendation seriously, and be proactive in helping to ensure their employees get vaccinated against hepatitis A.”
Eight food establishments in Kanawha, Putnam and Cabell counties have been identified as having a food service worker confirmed with hepatitis A. In each of those instances, a history of drug use was identified in an employee. To date, no customer of any of the food establishments impacted thus far have become ill by eating food provided by the facility.
KCHD will provide mass vaccination clinics to help accommodate food service employee schedules in Kanawha and Putnam counties.
Mass vaccination clinics for hepatitis A are scheduled for:
- May 25 Kanawha-Charleston Health Department; 8:00 a.m. – 6:00 p.m.
- May 30 Charleston Civic Center; 8:00 a.m. – 6:00 p.m.
- June 1 St. George Conference Center (Court and Lee Streets); 8:00 a.m. – 6:00 p.m.
“It’s important to remember the risk of hepatitis A transmission to the general public remains low,” Gupta added. “I have directed the purchase of an additional $550,000 in hepatitis A vaccines to support these clinics and to help eliminate cost as a barrier of getting the vaccine. We anticipate this outbreak will continue for quite some time as it has in other states and we must remain vigilant in our efforts to protect the public’s health.”
Statewide, there have been 106 confirmed, probable, and suspected cases of hepatitis A. Most (87%) of those cases in have occurred in Kanawha (59) and Putnam (28) counties, with Cabell at 10, and Boone, Jackson, Lincoln, Wayne and Wyoming counties having less than five cases each.