New cases of hepatitis A in Wayne County dwindle, but still among nation's worst

RICHMOND, Ind. – Newly released data shows Wayne County has continued to see a drop-off in new cases of hepatitis A in recent weeks, reflecting a trend seen on a national scale.

The county saw three new cases of the virus in the last week, keeping it among state and national leaders in the category even as local health officials continue pushing for more people in the area to be vaccinated.

According to figures released Friday morning by the Indiana State Dept. of Health, the county now has 97 new cases; the next closest county on the list — as it has been for the last few weeks — is Clark County, which has seen 74 cases, an increase of one from previous counts. The state generally sees about 20 cases of hepatitis A each year.

Wayne County in recent weeks has seen a slowdown in new cases, dropping drastically from the previous average of 14 new cases per week reported by state health officials for a large portion of the summer.

Even so, the county has been among the nation's leaders in total confirmed cases of hepatitis A since at least mid-August, and a slowdown in new cases has not changed its position.

Statewide, only 11 new cases of hepatitis A were reported in the last week — a drop-off of more than 60 percent compared to previous weeks. Since the start of the outbreak, 450 cases have been reported statewide, including 196 that resulted in hospitalization and one that resulted in death.

One thing that could be playing a role in the dwindling number of new cases, local health officials have said, might be the ongoing vaccination effort. Nearly 500 people received inoculations in the past week in Wayne County.

The numbers include vaccinations offered by local health departments, but it is unclear whether shots administered by pharmacies and doctors offices are included in the count.

The county has given 1,941 shots since the outbreak began, while statewide more than 66,000 shots have been administered.

PREVIOUS STORIES

►Aug. 31: Officials: No. 9 Grill employee worked while sick with hepatitis A

►Aug. 31: Wayne County, for hepatitis A, remains in nation's top 10

►Aug. 24: Wayne County among national leaders for hepatitis A

►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

►July 13: Centerville's Casey's General Store employee worked with hepatitis A

Wayne County Health Department last week reported a Cambridge City restaurant had an employee who worked, and potentially handled food, while sick with hepatitis A. 

Those who dined at No. 9 Grill were advised to receive vaccinations against the disease by Tuesday, Sept. 4, to protect themselves against the virus's spread, which occurs through fecal-oral contamination, often after someone does not wash their hands after using the restroom. It's not clear how the individual contracted the disease.

Also unclear is how many of the county's new instances of vaccinations were a direct result of the public health warning, or whether any of the new cases of hepatitis A were related to the No. 9 Grill matter. County and state health officials do not release information about individual cases unless they involve someone who might pose a public health risk.

Another local business, Casey's General Store in Centerville, was the subject of a similar health warning in mid-July, when one of its employees was found to have worked while infected. Unlike in the No. 9 Grill case, the county was able to offer a free vaccination clinic for those affected during that instance because it had time to procure vials of the vaccine from the state health department.

The ISDH, the Wayne County Health Dept. and the Centers for Disease Control and Prevention have repeatedly implored at-risk groups to be among the first in line to receive shots. If an individual is considered to be among the following groups, they are eligible to receive a vaccination free of charge as part of the the state and county's effort to preserve public health:

• 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.

Those who are not considered part of the at-risk population can receive the vaccine through the health department for $99 out of pocket, though most insurance providers will cover part or all of the cost of the inoculation. A second inoculation administered six months later, which serves as a booster, is generally covered in part by insurance, as well. Several local pharmacies are also believed to offer the vaccine.

The hepatitis A virus can live within an infected person for up to seven weeks without showing symptoms. When symptoms do begin showing, they generally include loss of appetite, nausea, tiredness, fever, stomach pain, brown-colored urine and light colored stools, as well as jaundice.

Stagnation of new cases occurring nationally, numbers show

The Palladium-Item has continued to collect data from public health agencies in eight states the CDC considers part of a nationwide outbreak — Arkansas, Indiana, Kentucky, Michigan, Missouri, Ohio, Utah and West Virginia — in an effort to determine the counties with the most confirmed instances of hepatitis A.

The data set excludes California and Tennessee, both of which were at one point considered outbreak hotbeds by the CDC, because they 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. California has also not been viewed as a hotbed of new hepatitis A cases since January.

Neither Arkansas nor Ohio has a county considered to be in the top 10 nationally. A county in Utah reduced its confirmed cases to 193, from 195, in its latest report.

The information presented in the newspaper's compiled list is accurate as of Friday, though most states release their data publicly at other times in the week and some, including Kentucky and Utah, respectively, release new data on a delayed or bi-weekly schedule.

Wayne County has maintained a steady No. 10 rank in the list with only a handful of other counties coming within that figure. The county still trails No. 9, Butler County, Mo., which saw a bump of four new cases in the last week.

Though both counties were among the handful that saw minor increases in their numbers — a West Virginia county, the national leader, increased by 22 new cases — the new figures show the continued spread of the hepatitis A virus has markedly stagnated in recent weeks.

The significant drop-off in new cases, combined with the apparent lack of fast-rising counties with fewer cases, could mean Wayne County will remain in the nation's Top 10 for the remainder of the outbreak.

Nation's top 10 counties for hepatitis A cases

No. 1: Kanawha County, W. Va., 599 cases (+22 new cases); population of 188,300

No. 2: Jefferson County, Ky., 269 cases (no change); 771,200

No. 3: Macomb County, Mich. 222 cases (no change); 864,900

No. 4: Cabell County, W. Va., 207 cases (+5); 96,844

No. 5: Salt Lake County, Utah, 192 cases (-2); 1.1 million

No. 6: Detroit, Mich., 173 cases (+1); 713,800

No. 7: Wayne County, Mich., 154 cases (+3); 1.76 million

No. 8: Oakland County, Mich., 120 cases (no change); 1.2 million

No. 9: Butler County, Mo., 101 cases (+4); 43,000

No. 10: Wayne County, Ind., 97 cases (+3); 70,000

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