Wayne County's hepatitis A numbers don't seem to be slowing down

RICHMOND, Ind. – More than half of the state's new cases of hepatitis A in the past week came from Wayne County, as the liver-affecting disease continued to rifle its way through the area.

While new cases of the virus have generally appeared to stagnate in most of Indiana, Wayne County has seen a steady, rapid increase in reported incidents in recent weeks. 

The Indiana State Dept. of Health on Friday reported Wayne County has seen 60 total cases reported since the start of the year, up from the 45 reported last week. The county accounted for 15 of the 29 newly-reported cases in that span, according to the state.

The spike was the largest one-week jump in reported cases for the county since the outbreak began.

►LAST WEEK:Local hepatitis A numbers double in two weeks' time

Unlike other areas that have been hit hard by hepatitis A, vaccinations and other efforts to stem spread of the disease have not seemed to have an impact on the local health environment.

In fact, the county is on pace to by next week surpass Clark County, which has seen 69 reported cases and is generally considered something of an epicenter for the disease in Indiana; health officials have attributed the origin of the hepatitis A outbreak, at least in part, to Louisville, which sits directly across the Ohio River from Clark County.

No other county aside from Wayne in the past week saw an increase of more than two cases of hepatitis A. The only other county in East Central Indiana with at least five cases of the disease is Fayette, which just had its fifth case reported this week. A majority of the other hardest hit counties are in southern Indiana.

Hepatitis A is caused by fecal contamination coming into contact with individuals, objects, foods and drinks and generally transfers through fecal-oral routes. While illicit drug use is most commonly associated as a risk factor for hepatitis C, health officials have warned that unhygienic handling of needles can cause transfer of hepatitis A, as well.

"Just the lack of hygiene; that fecal-oral contamination, that contamination that's on your hands after you go to the bathroom and maybe don't cleanse as well, and then use a needle," State Health Commissioner Kristina Box said last week. "That can allow you to get infected with (hepatitis A)."

Sufficient hand washing is often encouraged as a way for the general public to minimize the risk of exposure and transfer of the disease, which can stay dormant in a person for up to seven weeks before symptoms are displayed. Vaccinations have also been encouraged by state and local health officials for those who believe they are at risk of exposure.

Those who are considered most at risk, according to the Centers for Disease Control and Prevention, include: 

• All children, at 1 year old
• Travelers visiting countries with high-rates of hepatitis A
• Family members and caregivers of recent adoptees from countries where the infection is common
• Men who have sexual contact with other men
• People who use injection and non-injection illegal drugs
• People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C
• People who are treated with clotting-factor concentrates
• People who work with hepatitis A infected animals or in a hepatitis A research laboratory

More than 1,100 vaccinations have been administered in Wayne County since the start of the year, including at least several dozen that have been offered at the county jail — correctional and detention facilities are often seen as a hotbed for the spread of disease — in recent weeks.

►DEEP DIVE: Why is Wayne County so prone to hepatitis A?

Most of the local vaccinations came after news that a worker at Casey's General Store in Centerville may have exposed some customers to the disease. Those at risk of exposure were those who bought food or drinks prepared by staff at the store between July 5 and July 12.

The Wayne County Health Department held a clinic July 19 during which more than 500 people received the first of two vaccinations for the disease. The second, booster shot (recommended about six months after the first) will be offered free of charge for those who do not have insurance or means of paying for the vaccine.

"There's no magic bullet for this," said WCHD executive director Eric Coulter. "All we can do is continue encouraging vaccinations and good practices."

Coulter said he believes the county's numbers continue to rise because of socioeconomic issues such as poverty and drug use, but noted that other communities face those struggles as well.

"I'm not really sure," he said. "We are just continuing to follow the state guidelines on dealing with the outbreak — that's really all we can do at this point." 

Around the state, nearly 57,000 inoculations have been provided to the public free-of-charge; ISDH is covering the cost of the shots through federal funding that was made available to combat a large-scale outbreak that at its peak included at least 10 states.

Even with the number of cases that have been reported so far, the disease has not reached what is generally considered epidemic proportions, according to Box. Currently about .09 percent of the 70,000 or so residents in the county have reportedly contracted the disease.

"We certainly have an outbreak, and Wayne County is one of the counties we're most concerned about," she said.

Because of stringent health privacy laws, it is unclear what has caused many of the cases around the state, and even locally. However, health officials are required to inform citizens of a risk in cases that could put public health at risk.

The disease has killed at least 61 people, including one Hoosier, and infected more than 5,500 since the start of 2018.

Mickey Shuey is the business reporter at the Palladium-Item. Contact him at (765) 973-4472 or mshuey@gannett.com. You can also follow him on Twitter: @MickeyShuey, or on Facebook: www.facebook.com/MickeyShuey.