HEPATITIS A - USA (61): (INDIANA, ARKANSAS, LOUISIANA)
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A ProMED-mail post
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International Society for Infectious Diseases
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In this update:
[1] Indiana
[2] Arkansas
[3] Louisiana

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[1] Indiana
Date: Thu 6 Dec 2018
Source: WTHR [edited]
https://www.wthr.com/article/ hepatitis-outbreak-indiana- hits-700-cases-past-year


Health officials warn Hoosiers to take precautions against hepatitis A because of an ongoing outbreak both here and in other states. The State Department of Health has confirmed 698 outbreak-related cases since last November 2017. Indiana normally only sees about 20 cases in a 12-month period.

"Hepatitis A vaccine is available from healthcare providers and pharmacies as routine preventive care," said Teresa Krupka, public health nurse for the Hendricks County Health Department. "Handwashing for 20 seconds with warm water and soap is also highly recommended."

Hepatitis A is usually transmitted person-to-person through fecal-oral routes or by consuming contaminated food or water. The CDC says people who use illicit drugs, people who are homeless, men who have sex with men, and people who are incarcerated are the most likely to contract hep A.

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[2] Arkansas
Date: 4 Dec 2018
Source: KATV [edited]
https://katv.com/news/local/ hepatitis-a-c-arkansas- outbreak-and-hidden-epidemic


Since February [2018], Arkansas has recorded the largest number of hepatitis A cases the state has seen since the virus's vaccine was approved in the United States back in the mid 1990s. The elevated number of cases is part of a nationwide outbreak predominantly affecting northeast Arkansas.

"In a normal year, we'll see 3-5 cases of hepatitis [A]," said Dr. Dirk Haselow, Ph.D. state epidemiologist for the Arkansas Department of Health.

As of November [2018], more than 200 cases of hepatitis A have been reported in Arkansas; a large majority of those cases have been concentrated in Greene, Clay, Craighead and Lawrence counties.

While the spread of hep A had previously been associated with improper hand-washing and transmission of fecal matter, research has found an increase in cases tied to injection drug use in addition to other risk factors, like chronic homelessness, in men who have sex with other men, and incarcerated populations. "We have people with these risk factors throughout the state," said Haselow. "The fact that it hasn't spread from there is, to some extent, good fortune, and we are trying our hardest to contain it where it is."

Hepatitis A vaccinations have been required for children in Arkansas since 2013 and had been suggested by the American Association of Pediatrics for about a decade prior. It's why the hep A outbreak in Arkansas is mostly affecting people between the ages of 20-65.

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[3] Louisiana
Date: Fri 7 Dec 2018
Source: The News Star [edited]
https://www.thenewsstar.com/ story/news/local/2018/12/07/ morehouse-sees-uptick- hepatitis-cases-state-numbers- climb/2240512002/


Over 1/4th of Louisiana's hepatitis A cases in 2018 have originated in Morehouse Parish, with 7 cases in the past 3 months. The state is experiencing an overall increase in hepatitis A this year [2018]. Case clusters in Morehouse Parish and Baton Rouge are fueling the spike.

"We are ending the year [2018] on having more cases than normal, but over the past 2-3 months, we have noticed an uptick in Morehouse Parish," said Dr. Frank Welch, medical director for the Louisiana Department of Health immunization program.

Baton Rouge also saw a cluster of cases previously, but no new cases have appeared over the past 2 infectious periods -- the time period in which an infection can be passed on to someone else -- according to Welch.

"There are hepatitis A outbreaks going on nationally and even in some of our close neighboring states, Arkansas and Tennessee," Welcoh said. "What we have noticed in the state of Louisiana is that we normally have about 15-20 cases of hepatitis A every year. So far, 24 cases of hepatitis A have been confirmed in Louisiana in 2018. You can imagine with just 15 cases in the state of Louisiana normally, 7 in Morehouse is a lot to us," Welch said.

Recent spikes of the disease nationwide are more often found in those who are or recently were homeless, people who have used injection or non-injection drugs, and people who have contact with those populations. The Morehouse uptick follows suit and cannot be tracked to a single event. Welch also said that there is the possibility that a recent uptick in hepatitis A cases in north Arkansas had impacts on the caseload as people migrate.

Welch said the Louisiana Department of Health takes reports of hepatitis A very, very seriously and has a 1-800 number for physicians or healthcare entities to report cases. The number is used for more than data collection and treatment guidance. "What the state wants to do is find that person's close contacts," Welch said. "We want to find out where they work and who their close contacts are."

[Byline: Ashley Mott]

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[The number of states with increasing rates of hepatitis A is rising. As in the states with the highest numbers, the epidemiology relates to inadequate sanitation and living conditions. To appropriately address these outbreaks, a change of the paradigm of prevention is necessary as occurred in San Diego county in California. It is not clear whether this is happening elsewhere. - Mod.LL

HealthMap/ProMED maps available at:
Indiana, United States: http://healthmap.org/promed/p/ 217
Arkansas, United States: http://healthmap.org/promed/p/ 208
Louisiana, United States: http://healthmap.org/promed/p/ 221 ]

See Also