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Published Date: 2019-01-10 00:11:28
Subject: PRO/EDR> Hepatitis A - USA (02): (OH, IN, FL)
Archive Number: 20190110.6249959
HEPATITIS A - USA (02): (OHIO, INDIANA, FLORIDA)
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International Society for Infectious Diseases
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[1] Ohio
Date: Mon 7 Jan 2019
Source: Ohio Department of Health [edited]
https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/outbreak-response-bioterrorism-investigation-team/news/newsevent1


Hepatitis A statewide community outbreak
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The Ohio Department of Health (ODH) and affected local health departments are investigating an increased number of hepatitis A cases in Ohio. ODH has declared a statewide community outbreak of hepatitis A after observing an increase in cases linked to certain risk factors since the beginning of 2018. Outbreaks of hepatitis A are occurring in several states across the USA, including neighboring states of Indiana, Kentucky, Michigan and West Virginia.

Hepatitis A is a vaccine-preventable liver disease that usually spreads when a person ingests fecal matter - even in microscopic amounts - from contact with objects, food or drinks contaminated by the stool of an infected person. Hepatitis A can also be spread from close personal contact with an infected person, such as through sex.

People at increased risk for hepatitis A in this outbreak include:
- People with direct contact with individuals infected with the virus
- Men who have sex with men
- People who use street drugs whether they are injected or not
- People who are incarcerated
- People experiencing homelessness
- People who have traveled to other areas of the U.S. currently experiencing outbreaks

Symptoms of hepatitis A include fatigue, low appetite, stomach pain, nausea, clay-colored stools and jaundice. People with hepatitis A can experience mild illness lasting a few weeks to severe illness lasting several months.

People who believe that they are at high risk for hepatitis A infection should contact their healthcare provider or local health department for information about vaccination. People who know that they have been exposed to someone with hepatitis A should contact their healthcare provider or local health department to discuss post-exposure vaccination options. Individuals who experience symptoms of hepatitis A should contact their healthcare provider.

Hepatitis A outbreak summary (as of 7 Jan 2019):
- Number of cases: 1370
- Illness onset range: 5 Jan 2018 - 29 Dec 2018
- Age range: 2-81 years
- Gender: 59% male
- Number of hospitalizations: 856 (63%)
- Number of deaths: 4
- Number of counties with cases: 66 (75%)

--
Communicated by:
ProMED-mail
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[Ohio had reported 1200 cases as of 17 Dec 2018. In 3 weeks, 170 new cases have been reported, an average of 57 cases/week. The state is currently 3rd in the number of cases of HAV behind Kentucky and West Virginia and no new figures have been forthcoming from these states for several weeks. - Mod.LL]

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[2] Indiana
Date: Fri 4 Jan 2019
Source: Indiana State Department of Health [edited]
https://www.in.gov/isdh/27791.htm


Indiana Hepatitis A Outbreak
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Since November 2017, the Indiana State Department of Health (ISDH) has been investigating an outbreak of acute hepatitis A virus (HAV). Cases have been infected with HAV strains genetically linked to outbreaks across the USA. Indiana has an average of 20 cases of hepatitis A per 12 month period.

Indiana is one of several states experiencing a hepatitis A outbreak, and outbreak-related cases have been confirmed across the state. Information on other outbreaks can be accessed from the CDC website. Transmission is presumed to occur person to person; no contaminated commercial food product has been identified. Based on CDC guidelines, populations who are homeless, transient, incarcerated or use illicit drugs and their close direct contacts are considered at increased risk of exposure to hepatitis A.

If you believe you have been exposed to hepatitis A or are homeless, use injection or non-injection drugs, were recently incarcerated, or had contact with someone who has hepatitis A, contact your healthcare provider about hepatitis A vaccine.

To reduce the risk of hepatitis A transmission, people who have not received 2 doses of hepatitis A vaccine may ask their healthcare providers for protection. Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers and before preparing meals for yourself and others. Do not attend work or school if you are experiencing symptoms of hepatitis A, which include nausea, vomiting, diarrhea, loss of appetite, tiredness, stomach ache, fever, dark-colored (cola) urine, light-colored stool and jaundice (yellowing of skin and eyes). Symptoms may take as many as 50 days from exposure to appear.

Using the outbreak definition, the ISDH will update this website each Friday to reflect counties that have 5 or more outbreak-related cases. The ISDH updated the outbreak definition on [20 Jul 2018] and may reflect additional cases that were not included in previous outbreak case counts.

Indiana hepatitis A outbreak data as of 4 Jan 2019

Cases: 861
Hospitalizations: 412
Deaths: 2

--
Communicated by:
ProMED-mail
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[As of 14 Dec 2018, Indiana had reported 777 cases. Over 3 weeks, 84 new cases have been reported, an average of 28 per weeks. - Mod.LL]

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[3] Florida
Date: 7 Jan 2019
Source: Florida Health [edited]
http://www.floridahealth.gov/diseases-and-conditions/vaccine-preventable-disease/hepatitis-a/index.html


The number of reported hepatitis A cases steadily increased each month since April 2018 and has remained at or above the previous 5-year average all year. The number of cases reported in December [2018] increased from the previous month and was the highest reported in 2018.

The image [in the URL] contains a summary of hepatitis A cases reported by month in 2018 as compared to the previous 5-year average. In December 2018, 147 cases of hepatitis A were reported, which is above the previous 5-year average.

From [1 Jan 2018] through [31 Dec 2018], 559 hepatitis A cases were reported in 31 counties.

The number of reported hepatitis A cases more than doubled from 2016 to 2017 after remaining relatively constant in previous years. Case counts in 2018 have exceeded those seen in previous years and are more than double the case counts in the last 5 years. The central Florida region had the highest hepatitis A activity levels in 2018. In 2018, 96% of cases have likely been acquired locally in Florida.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Florida had reported 413 cases as of 30 Nov 2018. In 4 weeks, 146 new cases had been reported, an average of 41 per week.

As the numbers of cases continue to rise in a number of states and news of smaller (so far) outbreaks occur in others, the question asked at the end of the last post by a Kentucky official: "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" is more and more relevant. We are seeing these outbreaks because of the inability of local governments to deal with marginalized populations among their midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. It must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations.

No new numbers from the leading states, Kentucky and West Virginia, have been published in more than 2 weeks. - Mod.LL

HealthMap/ProMED maps available at:
Indiana, United States: http://healthmap.org/promed/p/217
Ohio, United States: http://healthmap.org/promed/p/237
Florida, United States: http://healthmap.org/promed/p/212]

See Also

Hepatitis A - USA (01): (KY, TN) 20190104.6241686
2018
----
Hepatitis A - USA (65): (KY, WV, AL) 20181229.6226575
Hepatitis A - USA (64): (NM, AZ) 20181218.6213878
Hepatitis A - USA (63): (KY) 20181217.6212689
Hepatitis A - USA (62): (KY, WV) 20181211.6204048
Hepatitis A - USA (61): (IN, AR, LA) 20181209.6192447
Hepatitis A - USA (60): (KY, WV, FL) 20181203.6178495
Hepatitis A - USA (59): (KY, WV, OH) 20181127.6168161
Hepatitis A - USA (58): (NM) 20181121.6155802
Hepatitis A - USA (57): (PA, WV) 20181119.6154486
Hepatitis A - USA (56): (WV, TN) 20181114.6145681
Hepatitis A - USA (55): (OH, PA, MI) 20181108.6134074
Hepatitis A - USA (54): (NC) fatal 20181107.6131462
Hepatitis A - USA (53): (KY, WV) 20181105.6127128
Hepatitis A - USA (52): 2017 20181102.6124030
Hepatitis A - USA (51): vaccination of homeless 20181031.6123076
Hepatitis A - USA (50): (CA, IN, FL) 20181031.6121044
Hepatitis A - USA (49): (KY, WV) 20181029.6118525
Hepatitis A - USA (48): more cases, CDC recommendations 20181026.6112506
Hepatitis A - USA (47): (KY, WV, FL) 20181024.6105628
Hepatitis A - USA (46): (KY, WV, PA) 20181016.6094878
Hepatitis A - USA (45): (KY, WV, NY) 20181002.6065894
Hepatitis A - USA (44): (MA, TN) 20180925.6049219
Hepatitis A - USA (43): (KY, WV) 20180924.6048976
Hepatitis A - USA (42): (KY, WV) 20180919.6039246
Hepatitis A - USA (41): (KY, WV) 20180910.6020394
Hepatitis A - USA (40): (KY, WV) 20180906.6012457
Hepatitis A - USA (30): (WV, AR) 20180714.5905424
Hepatitis A - USA (20): (KY, TN) 20180527.5820929
Hepatitis A - USA (10): (KY, UT, MI) 20180307.5671905
Hepatitis A - USA: (HI) 20180107.5543399
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