Wayne County now a state, national leader in hepatitis A cases

RICHMOND, Ind. – Wayne County is now one of the nation's leaders in cases of hepatitis A, after 14 new cases were reported in the county within the last week.

The area has seen 85 reported cases of the liver-affecting virus this year, as part of a larger outbreak throughout Indiana and nine other states that began in 2017. The growth is part of nearly two-month-long trend that has placed the county among the national leaders in the number of cases.

The county has seen an average increase of about 14 cases per week — on par with the new reports this week — though little is known about the nature of the disease's spread because details are limited to protect the privacy and identities of those infected.

New numbers released Friday morning by the Indiana State Department of Health show the county surpassed the previous leader, Clark County, which had only two new instances since last week. Clark County's numbers have slowed significantly in recent weeks, as have those in most other areas around the state.

Local and state health officials have attributed the local spread of the virus, which occurs through fecal-oral contamination, to a lack of hygiene, the use of illicit drugs (not the act itself, but mishandling of the needles by unclean hands), and other factors.

EARLIER COVERAGE:

►Aug. 17: Wayne County still a leader in hepatitis A cases

►Aug. 12: Incidents of liver-affecting virus not slowing down

►Aug. 3: Local hepatitis A cases nearly double in two-week span

►July 25: Why has Wayne County had so many cases of hepatitis A?

►July 24: WCHD continues offering inoculations for hepatitis A

►July 19: County health department anticipates more vaccinations

County and state health officials have continued to encourage those most at risk of contracting the virus to be vaccinated. Since the start of the year, Wayne County has provided 1,204 inoculations, and those numbers are expected to continue to rise in the coming weeks and months.

In an emailed statement Friday, ISDH spokeswoman Greta Sanderson said the state continues to work with local health officials to ensure as many people as possible are receiving vaccinations.

"The Indiana State Department of Health has been working closely with the Wayne County Health Department during this outbreak, including targeted vaccination clinics set up for next week to reach those most at risk, which includes people who use illicit drugs, the homeless, men who have sex with men and those who are incarcerated."

Dozens of inmates at the Wayne County Jail also have been vaccinated and the jail has continued to take an active role in fighting the spread of hepatitis A, county Sheriff Jeff Cappa said last month.

More than 60,000 vaccinations have been administered in Indiana's 92 counties this year.

The Centers for Disease Control and Prevention has general guidelines for who should receive vaccinations for the virus:

• 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

The CDC has also stated the virus can remain in someone for up to seven weeks after they are infected and that when symptoms do start showing, they generally include: loss of appetite, nausea, tiredness, fever, stomach pain, brown-colored urine and light colored stools, as well as jaundice.

The agency and the ISDH recommend that anyone considered to be at-risk receive a vaccination within two weeks of a believed interaction with someone infected by the virus. A booster shot is also necessary for full immunity to the virus, but is not recommended until six months after the initial inoculation.

Those who are most at risk of infection are can receive a free vaccination from the county health department; those who would like to receive a shot and are not in that group are required to pay for the shot, just like all other vaccines. The cost through the WCHD is $99, but the shot is usually covered by most health insurers, as well as Medicaid and Medicare programs.

So far, 414 cases of hepatitis A have been reported in the state and — as with previous weeks — Wayne County accounted for nearly half of all new cases (29) in the last week. Indiana usually sees about 20 cases of hepatitis A each year. 

Wayne County's continued outbreak has led to it being among the most troubled areas in the United States in regard to the virus' spread.

More than 5,700 cases have been reported across more than 200 counties in 10 states since the national outbreak began in early 2017. California's extensive outbreak was considered to have subsided in January, while Indiana's didn't start until well into 2018.

Some health officials consider Jefferson County, Ky., where Louisville is located, to be the place from which the disease spread into Indiana.

Wayne County ranks at No. 10 nationally among counties and cities affected by the disease since the outbreak began, based on data collected by the Palladium-Item for this article.

The county also is No. 3 in the nation for most cases in smaller communities (under 100,000 in population), trailing Butler County, Mo., which has seen 94 reported incidents of the disease. A county in West Virginia that is similar in size to Wayne County has seen 83 cases; Putnam County has nearly 57,000 and is among the top five in that state.

In an email on Friday afternoon, Paul Weidle, acting director of CDC’s Division of Viral Hepatitis, stated, "Since March 2017, CDC’s Division of Viral Hepatitis (DVH) has been assisting several state and local health departments with hepatitis A outbreaks. These outbreaks spread through person-to-person contact, and have occurred primarily among persons who use injection and non-injection drugs, and/or persons experiencing homelessness, and their close direct contacts.

"As of Aug. 23, 2018, these outbreaks have affected 10 states, with more than 5,000 cases. To end these outbreaks, urgent action is needed to identify and vaccinate groups of people at increased risk for infection."

Most cases of hepatitis A in the United States

The Palladium-Item gathered data from public health agencies in eight states considered to be part of the CDC’s nationwide outbreak to determine the counties with the most cases of hepatitis A: Arkansas, Indiana, Kentucky, Michigan, Missouri, Ohio, Utah and West Virginia.

The data set excludes California and Tennessee, both of which were considered outbreak hotbeds by the CDC, but do not provide immediately-available data for incidents reported in specific counties; they instead break their states into regions comprised of several counties and cities.

Though some states have different release days for new information on their respective outbreaks, the information presented in the newspaper's list is accurate as of Friday; Arkansas and Ohio did not have a county considered to be in the top 10 nationally.

No. 1: Kanawha County, W. Va., 534 cases, (population of 188,300)

No. 2: Jefferson County, Ky., 268 cases (771,200)

No. 3: Macomb County, Mich. 223 cases (864,900)

No. 4: Cabell County, W. Va., 196 cases (96,844)

No. 5: Salt Lake County, Utah, 188 cases (1.1 million)

No. 6: Detroit, Mich., 172 cases (713,800)

No. 7: Wayne County, Mich., 148 cases (1.76 million)

No. 8: Oakland County, Mich., 118 cases (1.2 million)

No. 9: Butler County, Mo., 94 cases (43,000)

No. 10: Wayne County, Ind., 85 cases (70,000)

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