The Department for Public Health (DPH), within the Cabinet for Health and Family Services (CHFS) and the Louisville Metro Department of Public Health and Wellness (LMPHW), are reporting a hepatitis A-related death of a Louisville resident.
The individual had symptoms and laboratory test results that met the case definition for acute hepatitis A virus infection and also had additional health issues. This is the first known death from acute hepatitis A in Kentucky since the hepatitis A outbreak began in 2017, and most outbreak cases have been reported from the Louisville Metro area. Specimens were sent for further laboratory testing to confirm if this case is associated with the outbreak.
The multi-county outbreak of Hepatitis A remains ongoing with the DPH now reporting 150 cases. According to DPH, 124 of the cases were reported in Jefferson County. Outbreak-associated cases were also reported in Anderson, Boyd, Bullitt, Carter, Hopkins, Kenton, Leslie, Marion, McCracken, Russell, Spencer and Taylor counties.
DPH first reported the outbreak on Nov. 21, 2017. Similar to hepatitis A outbreaks in other states, the primary risk factors for Kentucky cases have been illicit drug use and homelessness. A single source of infection has not been identified and virus transmission is believed to be occurring through person-to-person contact. The 10-year average number of acute hepatitis A cases has been approximately 20 cases per year in the Commonwealth.
With DPH support, the Louisville Metro Department of Public Health and Wellness has given more than 4,700 immunizations against hepatitis A at homeless shelters, homeless camps and at agencies, such as the Phoenix Health Center, that provide medical services for the homeless. It has also been providing immunizations at its syringe exchange sites and in the Louisville Metro corrections facility to target drug users and prevent the spread of hepatitis A in the prison system.
Laboratory specimens for some cases have been sent for specialized genetic testing of the hepatitis A virus at the Centers of Disease Control and Prevention (CDC) in Atlanta to determine if Kentucky’s cases are associated with outbreaks in other states. To date, 38 cases from 45 specimens submitted to CDC had hepatitis A virus that genetically matched outbreaks in California and Utah.
People are at increased risk for hepatitis A if they have traveled to a country where the virus is common, are homeless or lack access to adequate bathing and restroom facilities, use illicit drugs, are men who have sex with other men, are any individual with sexual contact with someone who has hepatitis A, have a clotting disorder such as hemophilia, or are household members or caregivers of a person infected with hepatitis A.
The CDC recommends Hepatitis A vaccine for adults at increased risk and for any adult who wants to be protected from acute hepatitis A virus infections. The hepatitis A vaccine has been routinely recommended for children in Kentucky aged 12 through 23 months since 2006. Officials also recommend catch-up immunizations to prevent hepatitis A for children aged 2 through 18 years. Children in all public and private schools in Kentucky will need to be immunized with hepatitis A vaccine before starting school on or after July 1, 2018 unless their parents or legal guardians assert an exemption based upon religious beliefs.
Other than age-appropriate vaccinations, the best way to keep from getting hepatitis A is to wash your hands using warm water and soap, to handle uncooked food appropriately, and to fully cook food. Always wash your hands before touching or eating food, after using the toilet, and after changing a diaper.
The virus is found in the stool of people infected with acute hepatitis A and is usually spread from person to person by putting something in the mouth (even though it might look clean) that has been contaminated with the stool of a person infected with hepatitis A. A person infected with hepatitis A virus can transmit the virus to others for up to two weeks before they develop acute illness.
Signs and symptoms of hepatitis A include jaundice (yellowing of the skin or eyes), dark-colored urine, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever, and grey-colored stools. Persons with symptoms should seek medical care for prompt diagnosis and treatment.
Additional information about hepatitis A can be found from the CDC at https://www.cdc.gov/hepatitis/hav/index.htm.