Cabell is past peak in hep A outbreak

September 28, 2018

HUNTINGTON — Cabell County’s hepatitis A outbreak appears to be two months past its peak as the frequency of local cases continues to decline gradually, according to the Cabell-Huntington Health Department.

The county, with 216 confirmed cases, has consistently ranked second statewide behind Kanawha County and its current 644 cases, which alone account for nearly half of West Virginia’s 1,318 hepatitis A diagnoses. The recent outbreak, which began locally in March, has contributed to at least two deaths in West Virginia.

“We’re still seeing more cases than we normally should, but the frequency has reduced compared to June and July,” said Dr. Michael Kilkenny, physician director at the Cabell-Huntington Health Department. “It appears the peak of the epidemic occurred in July and has been gradually reducing since, but it is far from over.”

The decline, however, gives no indication of when the number of new

hepatitis A cases will return to more typical levels, Kilkenny said. Cabell County had not had a diagnosed case in the past five years, but at its peak averaged 20 new cases per week through July.

Secondary peaks are still possible, Kilkenny added, and he warned against public complacency toward thorough handwashing and receiving the hepatitis A vaccinations — touted as the two most effective prevention methods.

The health department and private health providers have administered “tens of thousands” of vaccinations locally as the still-active outbreak continues, he said.

“We’re still seeing cases among unimmunized adults, and as active as we’ve been, we continue to see almost one new case per day,” Kilkenny said. “And these are all preventable.

“The fact that it is declining is encouraging, but if we drop our guard, it will just rebound. We see that often in dealing with infectious diseases.”

Kilkenny noted that a decline in Cabell County does not indicate hepatitis A is declining across the region, as diseases tend to spike in different areas at different times.

Kanawha County has seen a slight decrease in the amount of new hepatitis A cases, though not as significantly as Cabell County, wrote Allison Adler, communications director for the West Virginia Department of Health and Human Resources.

Statewide, hepatitis A continues to command a significant amount of public health attention. West Virginia has averaged about 70 new case reports weekly for the past eight weeks.

“As more of the at-risk population becomes infected or vaccinated, communities may see cases start to level off, but this does not mean the outbreak is over as cases are being identified in new counties each week,” Adler wrote in an email Wednesday.

It may take nine months for the state to see a widespread decline in new cases, Adler added. In other states, hepatitis A outbreaks are known to have lasted one to two years.

The full report by the West Virginia Department of Health and Human Resources is updated each Friday and can be accessed at https://dhhr.wv.gov/oeps/disease/viral-hepatitis/pages/hepA_outbreak.aspx.

The current outbreak began in San Diego in November 2016 and spread through southern California, primarily through the region’s homeless and drug-using populations. Around 700 cases were reported in California, including 22 deaths, and required the mass immunization of about 123,000 people. The California outbreak lasted until April 2018. The disease has since spread to seven other states, including West Virginia, Kentucky and Indiana.

Locally, most cases are confined to the region’s “at-risk” population — described as the homeless, transient, the recently incarcerated and drug users. Intravenous drug use was reported by 64 percent of West Virginia’s hepatitis A patients.

There also have been no cases of hepatitis A being spread through food — a concern raised as local health departments announced certain restaurant employees had contracted the disease. Since February, 24 employees at 24 different restaurants between Boyd County, Kentucky, and Kanawha County, West Virginia, have contracted the virus, though no new diagnoses among food workers have been reported since June 19.

Hepatitis A is a viral disease of the liver and is spread from person to person by the “fecaloral” route, often by inadequate handwashing after using the toilet or changing diapers. Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person.

It can take up to 50 days after exposure to the virus for someone to become ill, but most people experience symptoms within 28 to 30 days after being exposed. There is a two-week window for those who might have been exposed to receive the hepatitis A vaccine. After the 14-day window has closed, the vaccine might not be effective.


To view the full report on West Virginia’s statewide hepatitis A outbreak by the West Virginia Department of Health and Human Resources, including county-by-county totals updated each Friday, visit https://dhhr.wv.gov/oeps/disease/viralhepatitis/pages/hepA_outbreak.aspx.

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