Kentucky's hepatitis A outbreak is the worst in the nation

The deadly hepatitis A outbreak in Louisville and other parts of Kentucky is now the worst in the nation.

And the crisis hasn't crested.

Statewide, at least 969 people have contracted the liver disease, state health officials confirmed Wednesday.

"It's the worst on record across the nation and in Kentucky," said Dr. Jeff Howard, Kentucky Commissioner of Public Health.

Kentucky's confirmed cases have surpassed those in Michigan, which had 846 reported cases as of June 20, according to data from state health departments and the U.S. Centers for Disease Control and Prevention.

Kentucky's current outbreak already has targeted four times more victims than the state's last epidemic in 1988. Only one died then.

Q & A on hepatitis A:What you should know about hepatitis A and the outbreak in Louisville

The current crisis has killed six. Three of those deaths were in Louisville.

Louisville health officials confirmed 482 cases, said Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness. That's the worst outbreak here in decades, he said. He couldn't confirm if it's the worst outbreak in the city's history.

"Sharing a home, a cigarette, marijuana joint, a drink, or sex with someone who has the virus puts you at high risk," according an advisory on the city's website.

The eight other states that have reported outbreaks include: Indiana, California, Missouri, Ohio, Tennessee, Arkansas, Utah and West Virginia, CDC spokeswoman Donnica Smalls said.

The virus was first detected in Louisville last fall and mostly impacts drug users and adults who are homeless or people who work with them. It can be spread through contact with objects, surfaces, food or drinks contaminated by feces or stool from an infected person.

So why get vaccinated?

About 10 percent of Louisville's victims weren't in a high-risk category.

One example is Angela Glotzbach, a medical sales rep who was among Louisville's earliest victims. She was baffled by her diagnosis. She described missing work for three months due to virus symptoms that felt "1,000 times worse than the flu."

Dehydration from vomiting and diarrhea sent her to the hospital three times and she suffered tremors, joint and back pain, fatigue and trouble forming sentences.

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Glotzbach spoke with a local epidemiologist in November, when there were just 20 local victims.

She was diagnosed in October but believes she contracted the disease in late August or early September from one of the many restaurants she frequents.

Louisville and Kentucky health officials say they haven't found one confirmed case linked to a patron eating at a restaurant despite some restaurant workers contracting the virus. Regardless, many restaurant workers have been vaccinated as a precaution.

"The risk of contamination is extremely low" if contaminated food-handlers wash their hands or wear gloves, Howard said.

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Symptoms can take one to two weeks — even up to seven weeks — to surface and include darker urine, lighter stools, flu-like symptoms and yellowing of the eyes and skin.  

CDC epidemiologists have been studying Kentucky's outbreak for months, with trips and calls to Louisville. 

"This is occurring in many, many states," Howard said, with Louisville considered one of the ground zeroes. "Most of our cases are linked to the San Diego-Utah outbreak."

He also said there have been cases in Kentucky of the same strain as some, but not all, of the cases in Indiana as well as cases in the Detroit, Michigan, area and Arkansas.

Kentucky's drug epidemic has played a role in fueling the hepatitis A outbreak, with more than half of the state's cases linked to illicit drug use.

Less than one percent of the Kentucky cases have been fatal, considered a low rate, Howard said.

That's not simply luck.

Kentucky health officials identified the outbreak early and developed a plan of attack that included securing vaccines, notifying the public and the CDC and vaccinating people at homeless shelters and camps, needle exchange sites and at jails.  

Also, 59 percent of the victims in Kentucky have been hospitalized with acute abdominal pain, jaundice and other symptoms — likely preventing more deaths, Howard said.

The 11 other counties reporting five or more cases are: Ballard, Grayson, Ohio, Rowan, Shelby, Whitley, Fayette, Powell, Lincoln, Grant and Bourbon. State health officials are working to get them funding for vaccines and to coordinate with local jails and agencies providing services to people who are homeless or abusing drugs. The other deaths were in Ballard, Meade and Greenup counties.

Rui Zhao, communicable disease supervisor for Louisville Metro's health department, said 63 percent of Jefferson County's victims reported illicit drug use, but that percentage is likely higher.

"There's a lot of fear they will get in trouble. But if they tell us about drug use, we don't share that information with law enforcement," he said.

Zhao also said people can be hesitant to share personal details such as sexual encounters between men, which is a risk factor.

He cautioned residents who don't have these risk factors against feeling immune because the virus is "indiscriminate."

Langdon said he's optimistic that Hep A cases are beginning to drop in Louisville. "However, the community shouldn’t be falsely secure. It can start to trend up again."

Some residents may wonder if they had the vaccine as a child and didn't know it.

Dr. Paul Schulz, infectious diseases specialist and system epidemiologist for Norton Healthcare, said that's unlikely unless they traveled abroad or were in a high-risk population. That's because the vaccine wasn't available until 1995 and wasn't added to the child immunization schedule until 1999, he said.

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Only a small number of children have contracted the virus in Kentucky and all survived, Howard said. 

Public schools across Kentucky are requiring students to get the vaccine before starting school this year.

Some people may have had very mild symptoms and not have known they were suffering from hepatitis A, Schultz said. Symptoms tend to be much more severe for adults.

A primary care provider or infectious disease specialist can perform a simple blood test to see if someone has been vaccinated or has immunity, the doctor said.

But if you unknowingly got the vaccine twice, it won't harm you, said Lori Caloia, medical director for the health department.

Kroger and Walgreen pharmacies are among those offering the vaccine, with most insurance plans covering the cost.

Nearly 77,000 people have gotten the shot in Jefferson County.

Passport Health Plan members don't have to get prior authorization and more than 20,000 have gotten the shot across Kentucky this year at pharmacies or from their healthcare providers, spokesman Michael Rabkin said.

Concerns that there could soon be a vaccine shortage are unfounded, Howard said. He and Dr. Sarah Moyer, Louisville's health director, teamed to secure more of the vaccine from Merck — and at a discount.

Louisville's health department put together an online resource page at LouisvilleKy.gov — search for "hepatitis" — that lists many places offering the shot. The first shot is up to 95 percent effective and a second shot is recommended after six months.

When Louisville suffered its last outbreak in 1988, more than 200 victims contracted the virus, including Rick Hancock, then a Louisville firefighter. Contaminated lettuce on a ham sandwich from a downtown lunch spot that is no longer open caused him to miss three months of work.

"I can remember laying in there in my bed when I was sickest, thinking, 'Gosh, I'm glad I don't have a gun in this house,' " he said.

It took three more months of fatigue before he felt semi-normal.

He urges everyone to get the shot, a measure of protection that could have saved him a lot of suffering. 

Reporter Beth Warren: bwarren@courier-journal.com; 502-582-7164; Twitter @BethWarrenCJ. Support strong local journalism by subscribing today: www.courier-journal.com/bethw.