Cases of hepatitis A continue to rise in Louisville despite public health efforts to curtail an outbreak that’s been dogging the city for months.

Louisville has had more than 80 cases of acute hepatitis A since August 2017, according to the Louisville Metro Department of Public Health and Wellness. At least 34 local cases of the contagious liver infection have popped up since Jan. 1.

Dr. Lori Caloia, Louisville Metro Department of Public Health and Wellness

“In a typical year, we would see one to two cases in Louisville and 20 in the state,” so these cases are “much more than what we normally would see,” said Dr. Lori Caloia, the department’s medical director.

The outbreak is mainly affecting people who use illicit drugs of any sort — not just intravenous drugs — and the homeless.

“A ton of people that have been infected have been in one of those two categories, or both,” Caloia said.

“We consider it an infection that’s associated with poor sanitation and hygiene,” she said. Homeless people “don’t have a lot of great sanitation if they’re living on the street.”

To try to reduce the spread of the hepatitis A virus, about 4,000 at-risk people have been vaccinated as part of a blitz by Public Health and Wellness and community partners, such as Family Health Centers — Phoenix, the Louisville Rescue Mission and others.

Hepatitis A vaccine | Courtesy National Institute of Diabetes and Digestive and Kidney Diseases

“The Health Department came to the shelter last month and vaccinated all our residents,” said Nina Moseley, chief operating officer of Wayside Christian Mission, which serves the homeless. “This month, they are coming to our Hotel Louisville location on Feb. 20 to vaccinate all our residents at this location. It’s very important to us that we do all we can to maintain the health of our homeless men, women and children, many of whom are already in poor health.”

Public Health and Wellness also has been giving out hepatitis A vaccine through its Louisville Metro Syringe Exchange at 400 E. Gray St. and neighborhood syringe sites. They tend to attract people who may be reluctant to go to a doctor’s office to ask for vaccination, Caloia said.

One shot is about 90 percent effective, according to Public Health and Wellness. But two shots are needed for long-term protection, according to the U.S. Centers for Disease Control and Prevention.

Not just Louisville

The state declared a hepatitis A outbreak in Kentucky in November after 31 cases of acute hepatitis A in more than a dozen counties, according to the Kentucky Department for Public Health. It’s now identified more than 90 cases since January 2017.

Kentucky is not alone in battling hepatitis A. “Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah,” according to the state Department for Public Health.

Locally, some patients have required hospitalization, but “we have been lucky in Louisville, so far, that we have not had any deaths that we know of,” Caloia said.

Symptoms can include fever, fatigue, nausea, vomiting, loss of appetite, yellowing of the skin and eyes, and stomach pain. Affected individuals also may have dark urine and pale stools.

The illness, which can last for months, is often spread through what health officials refer to as the “fecal-oral route.”

In other words, “a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person,” according to the CDC. “Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.”

Hand washing reminder

Caloia said it’s important for people to wash their hands with soap and water before eating.

“Hepatitis A is not killed by hand sanitizer, so that makes it rather difficult to help control in the homeless population,” especially when it’s too cold to bring out hand-washing stations, Caloia said. In the spring, “we might be able to re-approach that idea.”

Wayside said it takes a number of precautions to protect the homeless.

“We have consistently used universal precautions in our operations as the norm,” Moseley said in an email. “In all our kitchen operations, we require our workers, as well as volunteers, to wash hands thoroughly and to wear gloves and hairnets. During the Thanksgiving and Christmas festivities this year, I, personally, stood at the head of the line and made sure all volunteers serving the meals wore gloves and hairnets.”

Although hepatitis A can be spread through contaminated food, there are other possible methods of transmission. For example, among drug users, handling of drugs might be a route to spread the infection, Caloia said.

“If they’re in a house where they’re not using good sanitation and someone else uses the same restroom, even that could potentially spread it,” Caloia said.

Caloia urges local health care providers to discuss vaccination with at-risk patients. “They can definitely help assist us by offering and helping their patients get vaccinated,” she said.

Getting vaccinated

Local health officials are encouraging the homeless and drug users to get vaccinated against hepatitis A. For more information, call the Louisville Metro Syringe Exchange, 400 E. Gray St., at (502) 574-6520, or Family Health Centers — Phoenix, 712 E. Muhammad Ali Blvd., at (502) 568-6972.

If you’re someone else who wants to get vaccinated, contact your primary care physician or another vaccine provider, such as Kroger.

Children

The Advisory Committee on Immunization Practices recommends hepatitis A vaccination of children at age 1. Starting July 1, the state of Kentucky will require all students in kindergarten through 12th grade to provide proof of having received two doses of hepatitis A vaccine, according to the Jefferson County Public Schools. The doses are given six months apart.

Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.


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