Health officials say a restaurant worker in northern West Virginia has contracted hepatitis A.
The Monongalia County Health Department says in a news release the worker at the Popeyes Louisiana Kitchen in Morgantown was potentially contagious between Sept. 30 and Oct. 16.
The statement says while the risk of contracting hepatitis A from a food worker is low, vaccinations are being offered to people who consumed food at the restaurant within the past two weeks.
Hepatitis A is a virus that infects the liver and is spread through food, water and objects tainted by feces, or through close contact.
Infection can range from a mild illness lasting a few weeks to a severe illness lasting several months.
The Centers for Disease Control and Prevention says West Virginia has had more than 2,500 hepatitis A cases since last year.
A new Centers for Disease Control and Prevention report examined a 2018 outbreak of Hepatitis A in West Virginia associated with drug use and homelessness.
Between January 1 and August 28, 2018, the Kanawha Charleston Health Department identified 664 cases of Hepatitis A. In August of 2018, the West Virginia Bureau of Public Health requested assistance from the CDC to deal with the outbreak. According to the report, the majority of patients testing positive for the disease reported current or past illicit drug use.
Hepatitis A, which is spread by a fecal-oral route, is vaccine preventable. After requesting assistance from the CDC, health officials began a statewide vaccination effort to control the outbreak, targeting homeless shelters, meal centers, jails and harm reduction centers. Kanawha County’s harm reduction program closed in March of 2018, prior to the request for help from the CDC.
As of February 2019, the CDC reports that the statewide outbreak is still ongoing, with 74 new cases of Hepatitis A in January, but only a handful of those were in Kanawha County.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.
Health officials in West Virginia say they’ve identified five more hepatitis A cases in food service workers.
The Kanawha-Charleston Health Department says a McDonald’s on Patrick Street in Charleston, a Pizza Hut on Third Street in Saint Albans, Paul’s Poplar Park Drive Inn in Scott Depot, Sakura on Nitro Place in Cross Lanes and Sam’s Club on Mountaineer Boulevard in South Charleston each had one worker identified.
Environmental Health Services Director Stanley Mills identified no unsafe food handling practices at any of the facilities.
The health department recommends patrons of the facilities monitor for hepatitis A symptoms and seek medical attention if symptoms occur.
The Centers for Disease Control and Prevention says hepatitis A is a communicable disease of the liver caused by a virus. It is usually transmitted person-to-person or by consuming contaminated food or water.
Health officials in West Virginia say two more food service workers have been diagnosed with hepatitis A.
The Kanawha-Charleston Health Department says in a news release one of them worked at a Taco Bell in Hurricane (HER’-a-kin) and the other at a Pizza Hut on MacCorkle Avenue in Charleston. The health department handles public health services for Kanawha and Putnam counties.
Department director of environmental health services Stanley Mills says no unsafe food handling practices were identified at either facility.
The state Bureau of Public Health says most of the dozens of hepatitis A cases in West Virginia have occurred in the Kanawha and Putnam counties.
The Centers for Disease Control and Prevention says hepatitis A is a communicable disease of the liver caused by a virus. It is usually transmitted person-to-person or by consuming contaminated food or water.
The first death in West Virginia related to an outbreak of hepatitis A has occurred in Kanawha County, health officials said Thursday, May 24.
The state Bureau for Public Health said in a news release that a 33-year-old Kanawha County resident died Wednesday. The statement said the victim had several conditions that contributed to the death.
State health officer Dr. Rahul Gupta said the resident had been hospitalized since being diagnosed with hepatitis A in early April. He said it’s unknown how the disease was contracted because health officials had not interviewed the victim.
Gupta said there have been 121 confirmed or suspected cases of hepatitis A in eight counties, most of them in Kanawha and Putnam counties.
The Centers for Disease Control and Prevention says hepatitis A is a vaccine-preventable, communicable disease of the liver caused by a virus. It is usually transmitted person-to-person or by consuming contaminated food or water. Symptoms include fatigue, low appetite, stomach pain, nausea and jaundice.
On Wednesday health officials urged hepatitis A vaccinations for restaurant and food service employees in Kanawha and Putnam counties. Three vaccinations clinics are scheduled over the next week in Charleston. Eight food establishments in Kanawha, Putnam and Cabell counties have been identified as having a worker confirmed with hepatitis A.
Gupta said the risk of hepatitis A to the general public remains low.
“People need not panic,” he said in a telephone interview. “Go visit restaurants and go about their daily living. Just exercise caution.”
A Hepatitis A outbreak growing in the Louisville area since last summer reached a new peak recently with a travel advisory from Indiana health officials. They told Hoosiers heading to Kentucky to get a Hep A vaccine.
Soon, Kentucky’s Acting Commissioner for Public Health Dr. Jeffrey Howard was pushing back.
“Let me say that it is safe to travel to Kentucky, and it is safe to attend the Kentucky Derby,” Howard said via the state’s official YouTube channel.
Kentucky Acting Public Health Commissioner Jeffrey Howard. Credit Still from KY Health Dept. video
What had looked like an isolated rash of cases in a few Kentucky counties has now become a multi-state, regional outbreak, with nearly 500 cases in four states and the numbers rising daily.. As with recent clusters of cases of HIV and elevated risk of Hepatitis C, this latest outbreak of Hep A is also closely linked to the region’s addiction crisis.
The immediacy and tragedy of overdose deaths in the Ohio Valley have overshadowed the risks of infections linked to the opioid epidemic. But with this latest outbreak, it’s clear that disease has joined overdoses as yet another public health threat from the addiction crisis.
Rapid Spread
West Virginia Public Health Commissioner Dr. Rahul Gupta said quick action is crucial. West Virginia declared an outbreak when 20 cases appeared in two counties. Usually, he said, the state’s total number of cases in a year will remain in the single digits.
“One of the things we understand in public health is when we have an outbreak of disease you can certainly accumulate a number of people having that disease very quickly,” Gupta said.
Credit Ashton Marra / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Dr. Rahul Gupta is Commissioner of the Bureau for Public Health in West Virginia, which has the nation’s highest overdose death rate.
In every affected state in the region the rates of infection are well above the norm. Ohio, which has about four dozen cases, has not declared an outbreak. But Ohio’s cases in the last four months already exceed the state’s total cases from last year.
Kentucky has reported more than 370 cases since first declaring an outbreak last summer. In previous years, the annual average had been about 20 cases.
Drug Connection
Another unusual factor in this Hep A outbreak is that drug users are at the core. Usually, Hep A outbreaks are caused by ingesting food contaminated with fecal matter. That often means the food is contaminated where it is grown or that a food service worker unwittingly passes on the disease through a restaurant.
But this outbreak is different, as Gupta explained.
“Individuals who may have substance use disorder and may be using illicit drugs may also not be able to keep up personal hygiene,” he said, “which puts them at higher risk for being infected with Hepatitis A.”
Howard, in Kentucky, said the Centers for Disease Control is tracking Hep A outbreaks in five states that show this unusual transmission. That means Hep A now joins overdose, Hep C and HIV as health threats linked to the addiction crisis. And monitoring and treatment efforts are complicated by the regional nature of the infection.
“The biggest challenge we face is when outbreaks cross state lines,” he said. He pointed to an ongoing investigation of a cluster of HIV cases in northern Kentucky, which includes many commuter communities tie to Cincinnati. That outbreak is also linked to needle drug use. “For the first time in the history of Kentucky, we had HIV transmission with the most common risk factor being intravenous drug use,” he said.
He also predicts more outbreaks linked to the addiction crisis.
“We will see more and more outbreaks in the upcoming months and years,” he said.
Gupta said death is relatively rare from Hep A. But the illness can be severe and last for several weeks. Symptoms include fever, fatigue, nausea, vomiting, dark urine, jaundice, clay-colored bowel movements and joint pain.
Hopeful Signs
There are some hopeful signs. First, the best prevention is a good hand wash with soap and water. Second, there is a Hep A vaccine. Since the vaccine first became available in 1995, U.S. cases of Hep A have declined by more than 95 percent.
The CDC targets vaccine supplies to highest risk areas and said that manufacturers are keeping pace with demand, although the agency is monitoring the supply situation. All regional health officials the ReSource contacted said vaccine supplies are adequate.
Credit Wikimedia Commons / User: Kallerna
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The CDC says Hepatitis A vaccines are in good supply.
Dr. James Gaskell is the health commissioner at the Athens City-County Health Department in Ohio. He said as outbreaks recently emerged he had his staff check the available supply.
Gaskell is confident an outbreak can be contained. But he said there are constant barriers to treatment in rural areas, barriers complicated by an increase in any infectious disease.
“Communication is a problem in Appalachia sometimes, even in today’s world,” he said.
Dr. Kraig Humbaugh is the Fayette County, Kentucky, Health Commissioner and previously served as Kentucky’s chief epidemiologist. He said it is tough to know the real magnitude of any outbreak.
“That’s true with almost any type of epidemic,” he said. “There’s always a certain percentage of cases that are hidden or they don’t get recognized.”
For example, a 2016 outbreak linked to imported foods caused reported cases of Hep A in the U.S. to rise 45 percent to about 2,000 cases. After adjusting for under-reporting, the CDC estimated the actual number of new infections in 2016 was closer to 4,000.
Humbaugh said the current outbreak will bring more attention focused on the region’s related health woes, and that could lead to more federal help.
“Unfortunately, there is a human cost and a financial cost, but it seems that we are getting more attention.”
Those costs, he said, will likely grow as the addiction crisis gives rise to more infectious disease outbreaks through the Ohio Valley.
ReSource reporter Aaron Payne contributed to this report.
