GESTIÓN EN SALUD PÚBLICA: ProMED-mail

miércoles, 5 de diciembre de 2018

ProMED-mail

Published Date: 2018-12-03 20:16:31
Subject: PRO/EDR> Hepatitis A - USA (60): (KY, WV, FL)
Archive Number: 20181203.6178495

HEPATITIS A - USA (60): (KENTUCKY, WEST VIRGINIA, FLORIDA)
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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In this posting:
[1] Kentucky
[2] West Virginia
[3] Florida

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[1] Kentucky
Date: Mon 3 Dec 2018
Source: Kentucky Cabinet for Health and Family Services, Department for Public Health [edited]
https://chfs.ky.gov/agencies/dph/Pages/default.aspx

Since [1 Aug 2017], the Kentucky Department for Public Health (DPH) has identified over 2000 cases of acute hepatitis A, a liver disease caused by the hepatitis A virus. An increase in cases since [1 Aug 2017], primarily among homeless people and drug users, prompted the declaration of a statewide outbreak in November 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

The DPH is working closely with the Centers for Disease Control and Prevention (CDC) and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of 24 Nov 2018:
•Total outbreak: 2865
•Hospitalizations: 1476
•Deaths: 18

Last updated: 3 Dec 2018

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[Date / Cases / Deaths / Average Cases Per Week
14 Apr 2018 / 352 / 3 / -
28 Apr 2018 / 448 / 4 / 48
25 May 2018 / 629 / 6 / 45
9 Jun 2018 / 832 / 6 / 101
27 Jun 2018 / 969 / 6 / 53
7 Jul 2018 / 1094 / 8 / 87
14 Jul 2018 / 1170 / 8 / 76
21 Jul 2018 / 1221 / 8 / 51
28 Jul 2018 / 1276 / 8 / 55
4 Aug 2018 / 1341 / 8 / 65
11 Aug 2018 / 1425 / 9 / 84
18 Aug 2018 / 1495 / 12 / 70
25 Aug 2018 / 1572 / 12 / 77
1 Sep 2018 / 1628 / 13 / 56
8 Sep 2018 / 1701 / 14 / 73
15 Sep 2018 / 1788 / 14 / 87
22 Sep 2018 / 1851 / 14 / 63
6 Oct 2018 / 2050 / 14 / 100
13 Oct 2008 / 2159 / 14 / 109
20 Oct 2018 / 2275 / 14 / 116
27 Oct 2018 / 2410 / 16 / 135
17 Nov 2018 / 2769 / 17 / 119
24 Nov 2018 / 2865 / 18 / 96

The cases in Kentucky continue to increase dramatically. The weekly number of new cases reported had remained with more than 100 new weekly cases over the past 2 reporting months, this week 96. No doubt it will be substantially over 3000 by year-end. - Mod.LL]

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[2] West Virginia
Date: Fri 30 Nov 2018
Source: West Virginia Department of Health and Human Resources, Office of Epidemiology and Prevention Services [edited]
https://dhhr.wv.gov/oeps/disease/viral-hepatitis/Pages/hepA_outbreak.aspx

Since March 2018, the West Virginia Bureau for Public Health has reported an increase in the number of confirmed cases of acute hepatitis A virus. This increase in cases has primarily been among injecting and non-injecting drug users, homeless or mobile individuals, and those who have been recently incarcerated. Viral sequencing has linked cases from Kentucky and California.

West Virginia hepatitis A outbreak cases as of 30 Nov 2018
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Number of cases 1963

Demographics
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Age range: 12-86
Median age: 37
Male: 1168 (59.5%)
Hospitalizations: 1010 (51.5%)
Deaths: 5

Risk factors
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Co-infection with hepatitis C (information available for 1534 cases): 892 (58.1%)
Co-infection with hepatitis B (information available for 1534 cases): 166 (10.8%)
Reports illicit drug use (information available for 1665 cases): 1232 (74%)
Homeless: 210 (10.7%)

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[Date / Cases / New Cases Per Week
23 May 2018 / 106
29 Jun 2018 / 404 / 59
13 Jul 2018 / 540 / 68
27 Jul 2018 / 699 / 79
24 Aug 2018 / 1031 / 83
31 Aug 2018 / 1109 / 78
7 Sep 2018 / 1166 / 57
14 Sep 2018 / 1225 / 59
21 Sep 2018 / 1318 / 93
28 Sep 2018 / 1395 / 77
12 Oct 2018 / 1527 / 66
19 Oct 2018 / 1603 / 76
26 Oct 2018 / 1671 / 68
2 Nov 2018 / 1725 / 54
9 Nov 2018 / 1774 / 49
16 Nov 2018 / 1859 / 85
23 Nov 2018 / 1907 / 48
30 Nov 2018 / 1963 / 56

The number of cases of acute hepatitis A reported each week had dropped over the last few weeks until last week, when 85 new cases (ca. 12/day) were reported, but has remained on 50 new reports per week. - Mod.LL]

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[3] Florida
Date: Thu 29 Nov 2018
Source: Florida Department of Health [edited]
https://www.floridatrend.com/public/userfiles/news/pdfs/hepaadvisory.pdf

Pursuant to the authority granted in Section 381.00315, Florida Statutes, Celeste Philip, MD, MPH, as state surgeon general and state health officer, determines that a public health advisory is necessary to protect the public health and safety, and hereby issues the following public health advisory.

Since January 2018, 385 cases of hepatitis A virus (HAV) infection have been reported in Florida. This is more than 3 times the previous 5-year average of 126 cases. The increase in hepatitis A cases to date is predominantly in the Tampa Bay and Orlando metropolitan areas. Most of the cases do not involve international travel exposures. Although infections have occurred across all demographic groups, approximately 68% of the recent cases are among males. The median age of cases is 37 years, and the highest rates of disease are among persons 30-49 years. Common risk factors include injection and non-injection drug use, homelessness, and men having sex with men (MSM).

Local and state health departments across the country have worked closely with the Centers for Disease Control and Prevention (CDC) to respond to similar outbreaks since March 2017. This year, health departments in Arkansas, California, Indiana, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Ohio, Tennessee, West Virginia, and Utah have investigated more than 8000 outbreak-associated cases of hepatitis A among persons who are homeless, persons who use drugs, men who have sex with men, and their close direct contacts.
HAV is transmitted person-to-person through fecal-oral route, which may include, but is not limited to, some types of sexual contact, and poor hand hygiene after going to the bathroom or changing diapers. HAV can also be spread through fecal-contaminated food or water. While most patients with HAV infections will fully recover, 77% of recent cases in Florida have required hospitalization.

The CDC Advisory Committee on Immunization Practices recommends that the following persons be vaccinated against HAV:
- All children at age one year;
- Persons who are at increased risk for infection;
- Persons who are at increased risk for complications from HAV;
- Users of injection and non-injection drugs;
- Persons who are homeless;
- Men who have sex with men;
- Persons who have chronic liver disease;
- Persons traveling to or working in countries that have high or intermediate endemicity of HAV;
- Persons who have clotting-factor disorders;
- Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate HAV endemicity; and
- Persons having direct contact with persons who have HAV.

Healthcare providers are also reminded to immediately report all cases of hepatitis A to your county health department to ensure a prompt public health response in order to prevent disease among close contacts.

The Department of Health will continue to work closely with community partners to raise awareness and promote vaccination by
- Providing education to persons who report drug use, homelessness, and/or MSM activity;
- Encouraging proper hand hygiene and offering HAV vaccination;
- Collaborating with community partners associated with Federally Qualified Health Centers, local jails, drug treatment centers, homeless shelters, hospitals, the Florida Department of Children and Families, and managing entities, among others, to increase vaccination access to their clients;
- Providing all high-risk clients who present to county health departments for various services (including HIV, STD, TB) with the opportunity to receive HAV vaccination;
- Encouraging support of the CDC recommendations for syringe services programs (SSP) to reduce new HAV infections by offering HAV vaccination to all high-risk clients who seek healthcare services at the SSP;
- Enhancing HAV and HAV vaccine information resources on the Department of Health's webpage and developing audience-specific educational materials for clients and the public;
- Providing regular updates and messaging to the medical community; and
- Continuing to work closely with the CDC to ensure Florida has sufficient vaccine and other resources for an effective response.

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[Those affected the most by the outbreaks of HAV in certain states of the USA are the marginalized cohorts of humanity, including homeless people and substance abusers. Their needs for adequate sanitation and living conditions were supplied in the San Diego (California) area, and such an approach to these outbreaks is required elsewhere in the USA. Spillover into other portions of the population, such as restaurant diners affected through infected food handlers, will continue. It is not clear how many of these rapidly increasing cases are in individuals outside the described cohorts.

Kentucky remains in 1st place in cases. West Virginia has roared past California and Michigan for 2nd on the HAV case-number list. With the 1963 number in West Virginia and Kentucky's 2865, these 2 states have reported a total of 4728 cases since their outbreaks started and certainly will reach well past 5000 by year-end.

Food-service workers continue to develop acute hepatitis A and put unsuspecting diners at risk. Although many are more local restaurants, recently a case in a food worker in a high-end Japanese restaurant in the Disney World complex was reported (http://www.fox13news.com/news/florida-news/worker-tests-positive-for-hepatitis-a-at-morimoto-asia-restaurant-in-disney-springs).

In the entire year of 2016, (https://www.cdc.gov/hepatitis/statistics/2016surveillance/index.htm), CDC reported only 2007 cases from all 50 states. - Mod.LL

HealthMap/ProMED-mail maps:
Kentucky, United States: http://healthmap.org/promed/p/220
West Virginia, United States: http://healthmap.org/promed/p/249
Florida, United States: http://healthmap.org/promed/p/212]