Michigan hit hard by deadly hepatitis A outbreak

A hepatitis A outbreak has hit several states across the country, killing dozens of people and potentially sickening ...

Posted: Jan 14, 2018 9:44 AM
Updated: Jan 14, 2018 9:44 AM

A hepatitis A outbreak has hit several states across the country, killing dozens of people and potentially sickening thousands. Michigan has been hardest-hit in terms of deaths, with 22.

The outbreak there began in August 2016 and, after a dropoff during the winter, continued to climb last year, according to the Michigan Department of Health and Human Services.

A hepatitis A outbreak continues in several states

Michigan has seen 22 deaths and 658 cases

"We currently have 677 cases in Michigan and continue to see approximately 15-20 cases matching into the cluster every week," Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services, wrote in an email. "The Michigan outbreak now includes 15 different county jurisdictions. We believe that person-to-person transmission is the primary route of infection."

Fighting the outbreak was challenging in some jurisdictions due to a national shortage of the vaccine for hepatitis A.

"Vaccine supply is still 'constrained,' " Sutfin wrote. "We continue to prioritize vaccine to the highest risk individuals that have been identified and focus our vaccination efforts in the parts of the state who are experiencing the largest number of cases."

Vaccine supplier Merck said the shortage of pre-filled syringes, the easiest to administer, would not ease until the second quarter of 2018. However, vials containing 10 single doses are available.

"The company is taking steps to continue to increase our capacity to meet demand globally in 2018," Merck spokeswoman Pamela Eisele wrote in an email. "We apologize for any inconvenience this supply availability may be causing."

The only other vaccine maker, GlaxoSmithKline, said it has adult hepatitis A vaccine in prefilled syringes in stock and is "working diligently to increase our supply." The company is also working closely with the US Centers for Disease Control and Prevention, spokeswoman Robin Gaitens wrote in an email, to ensure that its vaccines "are directed to areas of greatest need."

California epicenter: San Diego

In California, the outbreak can be traced to transient camps and illicit drug users in San Diego, officials say. Now, the state is in the middle of the biggest person-to-person outbreak of hepatitis A since the vaccine first became available in the mid-'90s, according to the California Department of Public Health. Though the virus has spread across the state, San Diego has seen the most deaths: 21, out of a reported 686 cases.

Officials say movement among the homeless population has also spread the virus to Utah, Arizona and Colorado. Cases of hepatitis A in Colorado doubled in 2017, specifically among "gay, bisexual and other men who have sex with unvaccinated men," said health officials. However, only one of those cases was linked to San Diego, according to Shannon Barbare of the Colorado Disease Control and Environmental Epidemiology Division, and the outbreak now appears to be over.

Over the weekend, officials in Utah announced a new outbreak at a convenience store in Salt Lake County that can be traced to San Diego.

"We have 97 outbreak-related cases in our county," Salt Lake County Health Department spokesman Nicholas Rupp said, adding that those cases were tied to a worker at a 7-Eleven who tested positive for the same strain of the virus as that in San Diego. "We are seeing similar hospitalization rates as San Diego, about 60%, but we have fortunately not seen any deaths."

Just south of Salt Lake, workers at two Utah County restaurants also tested positive for the virus in late December.

"In Utah, we don't require vaccinations for food workers against hepatitis A, but we are encouraging everyone who handles food to be vaccinated, and this is why," Rupp said. "And everyone should practice handwashing after being in public places to protect themselves from exposure."

Consumers who used the restroom at or ate at the two restaurants are at risk, health officials said, and those who visited the 7-Eleven and consumed any self-serve beverage, fresh fruit or items from the hot food case, such as pizza, hot dogs or chicken wings, may have been exposed. Packaged foods are not affected, according to the Health Department.

Rupp said the Salt Lake County Health Department has fielded hundreds of phone calls since it announced the 7-Eleven exposure Sunday and referred about 70% of those callers for vaccination.

"If they receive the vaccine within 14 days of exposure, the vaccine will act as a preventative to the virus," Rupp said, adding that exposure could only have occurred December 26 through January 3.

The state of Utah has confirmed 152 total cases as part of this outbreak; no deaths have been reported.

What is hepatitis A?

Hepatitis A is a highly contagious liver disease caused by the HAV virus. The virus is found in the feces of people with the disease and is most frequently transmitted by eating food or drinking water handled by someone who has not properly washed their hands. It also can be transmitted by sex and by illicit drug use.

Some of the most common symptoms include nausea, vomiting, fever, fatigue, loss of appetite and jaundice, or yellowing of the skin or eyes. It can take 15 to 50 days to show symptoms of the infection; however, an infected person is most contagious during the two weeks before their skin turns yellow.

Most people recover from the virus and are immune to further infection, according to the CDC, but some can develop liver failure that leads to death. That is most common in people with compromised immune systems, those older than 50 and those with other liver diseases.

According to the CDC, the hepatitis A virus is very hard to kill and can live for months outside the body. Hand sanitizers are not effective against the virus, so frequent handwashing is critical to controlling any outbreak.

Outbreaks of hepatitis A are normally small; rates have declined 95% since the vaccine became available in 1995. GlaxoSmithKline and Merck are the only companies approved by the Food and Drug Administration to sell a hepatitis A adult or pediatric vaccine in the US.

The current outbreaks of hepatitis A, virus genotype IB, is normally not found in the US; it's more common to the Mediterranean, Turkey and South Africa. However, the current vaccine is effective against all strains of the virus.

Minnesota Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 98447

Reported Deaths: 2072
CountyConfirmedDeaths
Hennepin27557932
Ramsey11167323
Dakota7692126
Anoka6281137
Stearns409424
Washington391855
Scott264833
Olmsted253528
Nobles197916
Blue Earth17366
St. Louis172542
Wright17017
Carver14467
Clay142441
Rice13478
Mower13446
Sherburne117714
Kandiyohi10563
Winona92018
Lyon7334
Waseca7228
Benton5633
Steele5552
Crow Wing55418
Nicollet54717
Freeborn5464
Watonwan5354
Chisago5171
Todd5072
McLeod5022
Le Sueur4764
Otter Tail4694
Beltrami4605
Martin44611
Goodhue3899
Pine3550
Douglas3522
Itasca35215
Polk3274
Isanti3191
Becker2842
Carlton2791
Morrison2702
Dodge2610
Pipestone23810
Chippewa2321
Cottonwood2290
Meeker2132
Wabasha2060
Sibley2023
Yellow Medicine1982
Brown1962
Cass1864
Rock1810
Redwood1783
Murray1742
Mille Lacs1693
Renville1618
Jackson1531
Unassigned15352
Faribault1470
Swift1441
Fillmore1330
Houston1300
Kanabec1288
Roseau1260
Koochiching1233
Hubbard1221
Pennington1201
Lincoln1180
Stevens1071
Pope1000
Aitkin841
Big Stone830
Wadena730
Wilkin713
Lac qui Parle681
Grant634
Lake600
Norman560
Marshall531
Mahnomen491
Red Lake451
Traverse340
Clearwater310
Lake of the Woods241
Kittson120
Cook70

Iowa Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 87828

Reported Deaths: 1332
CountyConfirmedDeaths
Polk16113264
Woodbury559768
Johnson517927
Black Hawk454192
Linn4163114
Story348517
Dubuque340242
Scott309528
Dallas282938
Pottawattamie220139
Buena Vista200312
Marshall179434
Sioux17073
Wapello134157
Webster131714
Plymouth118221
Clinton113921
Muscatine112855
Crawford11086
Cerro Gordo106421
Warren9696
Jasper87034
Des Moines8068
Henry7734
Marion7728
Tama75332
Carroll6955
Lee6527
Wright5971
Dickinson5426
Boone5268
Bremer5067
Washington48511
Delaware4413
Louisa43415
Mahaska42720
Lyon3754
Jackson3583
Floyd3573
Franklin35218
Clay3434
Winneshiek3408
Benton3381
Hamilton3343
Winnebago32313
Hardin3111
Poweshiek3118
Buchanan2921
Jones2893
Kossuth2860
Butler2792
Emmet27510
Chickasaw2701
Shelby2701
Clarke2693
Clayton2683
Sac2670
Allamakee2656
Guthrie2649
Harrison2593
Cherokee2572
Cedar2531
Fayette2382
Madison2342
Grundy2294
Iowa2221
Palo Alto2080
Hancock1992
Mitchell1970
Humboldt1943
Howard1927
Mills1911
Page1910
Calhoun1883
Osceola1770
Cass1762
Pocahontas1662
Monona1621
Monroe16211
Lucas1566
Appanoose1443
Union1423
Jefferson1401
Taylor1341
Davis1284
Ida1281
Fremont1220
Keokuk1191
Van Buren1181
Worth1090
Greene1050
Montgomery995
Audubon891
Wayne882
Adair731
Decatur670
Ringgold532
Adams330
Unassigned140
Rochester
Broken Clouds
59° wxIcon
Hi: 61° Lo: 42°
Feels Like: 59°
Mason City
Few Clouds
64° wxIcon
Hi: 62° Lo: 43°
Feels Like: 64°
Albert Lea
Scattered Clouds
61° wxIcon
Hi: 62° Lo: 43°
Feels Like: 61°
Austin
Broken Clouds
61° wxIcon
Hi: 63° Lo: 43°
Feels Like: 61°
Charles City
Few Clouds
63° wxIcon
Hi: 63° Lo: 43°
Feels Like: 63°
Winds pick up for Wednesday
KIMT Radar
KIMT Eye in the sky

Community Events