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Michigan hit hard by deadly hepatitis A outbreak

A hepatitis A outbreak has hit several states across the country, killing dozens of people and potentially sickening ...

Posted: Jan 14, 2018 9:44 AM
Updated: Jan 14, 2018 9:44 AM

A hepatitis A outbreak has hit several states across the country, killing dozens of people and potentially sickening thousands. Michigan has been hardest-hit in terms of deaths, with 22.

The outbreak there began in August 2016 and, after a dropoff during the winter, continued to climb last year, according to the Michigan Department of Health and Human Services.

A hepatitis A outbreak continues in several states

Michigan has seen 22 deaths and 658 cases

"We currently have 677 cases in Michigan and continue to see approximately 15-20 cases matching into the cluster every week," Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services, wrote in an email. "The Michigan outbreak now includes 15 different county jurisdictions. We believe that person-to-person transmission is the primary route of infection."

Fighting the outbreak was challenging in some jurisdictions due to a national shortage of the vaccine for hepatitis A.

"Vaccine supply is still 'constrained,' " Sutfin wrote. "We continue to prioritize vaccine to the highest risk individuals that have been identified and focus our vaccination efforts in the parts of the state who are experiencing the largest number of cases."

Vaccine supplier Merck said the shortage of pre-filled syringes, the easiest to administer, would not ease until the second quarter of 2018. However, vials containing 10 single doses are available.

"The company is taking steps to continue to increase our capacity to meet demand globally in 2018," Merck spokeswoman Pamela Eisele wrote in an email. "We apologize for any inconvenience this supply availability may be causing."

The only other vaccine maker, GlaxoSmithKline, said it has adult hepatitis A vaccine in prefilled syringes in stock and is "working diligently to increase our supply." The company is also working closely with the US Centers for Disease Control and Prevention, spokeswoman Robin Gaitens wrote in an email, to ensure that its vaccines "are directed to areas of greatest need."

California epicenter: San Diego

In California, the outbreak can be traced to transient camps and illicit drug users in San Diego, officials say. Now, the state is in the middle of the biggest person-to-person outbreak of hepatitis A since the vaccine first became available in the mid-'90s, according to the California Department of Public Health. Though the virus has spread across the state, San Diego has seen the most deaths: 21, out of a reported 686 cases.

Officials say movement among the homeless population has also spread the virus to Utah, Arizona and Colorado. Cases of hepatitis A in Colorado doubled in 2017, specifically among "gay, bisexual and other men who have sex with unvaccinated men," said health officials. However, only one of those cases was linked to San Diego, according to Shannon Barbare of the Colorado Disease Control and Environmental Epidemiology Division, and the outbreak now appears to be over.

Over the weekend, officials in Utah announced a new outbreak at a convenience store in Salt Lake County that can be traced to San Diego.

"We have 97 outbreak-related cases in our county," Salt Lake County Health Department spokesman Nicholas Rupp said, adding that those cases were tied to a worker at a 7-Eleven who tested positive for the same strain of the virus as that in San Diego. "We are seeing similar hospitalization rates as San Diego, about 60%, but we have fortunately not seen any deaths."

Just south of Salt Lake, workers at two Utah County restaurants also tested positive for the virus in late December.

"In Utah, we don't require vaccinations for food workers against hepatitis A, but we are encouraging everyone who handles food to be vaccinated, and this is why," Rupp said. "And everyone should practice handwashing after being in public places to protect themselves from exposure."

Consumers who used the restroom at or ate at the two restaurants are at risk, health officials said, and those who visited the 7-Eleven and consumed any self-serve beverage, fresh fruit or items from the hot food case, such as pizza, hot dogs or chicken wings, may have been exposed. Packaged foods are not affected, according to the Health Department.

Rupp said the Salt Lake County Health Department has fielded hundreds of phone calls since it announced the 7-Eleven exposure Sunday and referred about 70% of those callers for vaccination.

"If they receive the vaccine within 14 days of exposure, the vaccine will act as a preventative to the virus," Rupp said, adding that exposure could only have occurred December 26 through January 3.

The state of Utah has confirmed 152 total cases as part of this outbreak; no deaths have been reported.

What is hepatitis A?

Hepatitis A is a highly contagious liver disease caused by the HAV virus. The virus is found in the feces of people with the disease and is most frequently transmitted by eating food or drinking water handled by someone who has not properly washed their hands. It also can be transmitted by sex and by illicit drug use.

Some of the most common symptoms include nausea, vomiting, fever, fatigue, loss of appetite and jaundice, or yellowing of the skin or eyes. It can take 15 to 50 days to show symptoms of the infection; however, an infected person is most contagious during the two weeks before their skin turns yellow.

Most people recover from the virus and are immune to further infection, according to the CDC, but some can develop liver failure that leads to death. That is most common in people with compromised immune systems, those older than 50 and those with other liver diseases.

According to the CDC, the hepatitis A virus is very hard to kill and can live for months outside the body. Hand sanitizers are not effective against the virus, so frequent handwashing is critical to controlling any outbreak.

Outbreaks of hepatitis A are normally small; rates have declined 95% since the vaccine became available in 1995. GlaxoSmithKline and Merck are the only companies approved by the Food and Drug Administration to sell a hepatitis A adult or pediatric vaccine in the US.

The current outbreaks of hepatitis A, virus genotype IB, is normally not found in the US; it's more common to the Mediterranean, Turkey and South Africa. However, the current vaccine is effective against all strains of the virus.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 153270

Reported Deaths: 3807
CountyCasesDeaths
DeSoto10249104
Hinds10095199
Harrison7173111
Jackson6440124
Rankin5705103
Lee517095
Madison4902107
Forrest385986
Jones361788
Lauderdale3567147
Lafayette329752
Washington3197108
Lamar294750
Oktibbeha248462
Bolivar242484
Lowndes240464
Panola224852
Neshoba2225118
Marshall219450
Leflore206891
Pontotoc202429
Monroe201078
Lincoln192865
Sunflower191955
Warren177757
Tate175351
Union169526
Copiah165440
Pike163958
Yazoo157940
Scott156630
Itawamba155635
Pearl River153468
Alcorn152828
Coahoma151043
Simpson150353
Prentiss148431
Adams143151
Grenada141445
Leake138344
Holmes131561
Tippah126730
George126225
Covington124639
Winston123726
Hancock122840
Wayne119023
Marion117346
Attala116134
Tishomingo110042
Chickasaw108332
Newton107529
Tallahatchie97427
Clarke92453
Clay92327
Jasper83522
Stone78515
Calhoun77713
Walthall76929
Montgomery75425
Carroll73815
Lawrence72614
Smith72116
Yalobusha72028
Noxubee71917
Perry67726
Tunica61819
Greene60822
Claiborne58816
Jefferson Davis57817
Amite55214
Humphreys54319
Benton49618
Quitman4947
Webster45014
Kemper44218
Wilkinson40122
Jefferson35711
Franklin3485
Choctaw3457
Sharkey31717
Issaquena1174
Unassigned00

Alabama Coronavirus Cases

Cases: 247229

Reported Deaths: 3577
CountyCasesDeaths
Jefferson32718500
Mobile19904362
Madison13425148
Tuscaloosa13167154
Montgomery12380236
Shelby1046577
Baldwin882098
Lee778566
Morgan675150
Calhoun6366121
Etowah635166
Marshall630955
Houston532338
DeKalb489736
Cullman447442
Limestone430245
St. Clair425755
Lauderdale413354
Elmore409464
Walker3689111
Talladega353554
Jackson327123
Colbert314642
Blount294640
Autauga275142
Franklin254233
Coffee246515
Dale234454
Dallas226532
Chilton225038
Russell22313
Covington220334
Escambia198631
Chambers177250
Tallapoosa177091
Pike159214
Clarke158919
Marion141336
Winston134423
Lawrence129636
Pickens124218
Geneva12378
Marengo122524
Bibb118817
Barbour117511
Butler117342
Randolph103821
Cherokee102924
Hale97731
Fayette92216
Clay92024
Washington91619
Henry8676
Lowndes79929
Monroe79011
Cleburne77414
Macon74522
Crenshaw71230
Bullock70019
Perry6896
Conecuh68514
Lamar6838
Wilcox63918
Sumter58422
Greene42718
Choctaw42613
Coosa3464
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