Pat Kelsey Louisville contract: What to know about new basketball coach's salary, buyout
LOCAL

Kentucky racks up one-third of all hepatitis A deaths in US as fatalities keep rising

Chris Kenning
Courier Journal

The death toll has risen to 57 in Kentucky's hepatitis A outbreak, which has fallen from its peak but still hasn't been wrestled under control, according to the state's latest weekly report. 

Kentucky's deaths account for one-third of what the Centers for Disease Control said are at least 170 deaths nationally from hepatitis A outbreaks, which since 2016 have spread to 22 states, largely among the homeless and drug users.

The contagious liver disease has sickened 4,621 Kentucky residents since it was declared in November 2017, the state report found. It continues to rank as the nation's largest.

More: Kentucky's 'too low and too slow' response to nation's worst hepatitis A outbreak

Spread person-to-person, the virus has hospitalized 48% of its victims and hit 108 of Kentucky's 120 counties, with 15 counties reporting new cases in the week ending May 4.

"The outbreak is certainly waning, but it hasn't returned to the baseline" of about 20 cases a year, compared with about 20 new cases still being recorded in each of several recent weeks, said University of Kentucky epidemiologist Kathleen Winter.

While that's down from a high of 151 a week at its peak, "we are not in a situation where this outbreak is over," said Winter, who argued vigorous vaccination efforts are still needed.

Winter said the declines are likely a mix of vaccination efforts and the outbreak burning itself out as those infected become immune. 

The four new deaths in the latest report were identified through periodic reviews of death records, and some date back several months, officials said. The state does not disclose when or where they occurred.

Hepatitis A deaths are defined as any outbreak-associated cases with documentation of the virus as a contributing factor to someone's death. Drug users, the group most affected by the outbreak, often have other medical problems that can make them more vulnerable.  

Kentucky has recorded more deaths than any other state with an outbreak.

West Virginia and California, by comparison, each has had 21 deaths in their outbreaks. Michigan has had 28, and Indiana 4. Hepatitis A outbreaks since 2016 have sickened more than 17,000 people nationally.

Kentucky's outbreak first hit in Louisville, where officials began to contain by late spring 2018 after an aggressive response. But around the same time, hepatitis A exploded across rural Kentucky, catching fire to the state's vast rural drug abuse epidemic.

But some key former state health department officials criticized Kentucky's response, arguing health leaders opted against a more aggressive and costly response that could have curtailed the outbreak faster, leading to fewer illnesses and expensive hospitalizations. 

A Courier Journal investigation found that last spring, the state's former infectious diseases chief, Dr. Robert Brawley, recommended $6 million for vaccines and $4 million for temporary workers to help thinly staffed local health departments deliver vaccines to hard-to-reach drug users. He also called for a public health emergency declaration to help pave the way for federal assistance.

Instead, Department for Public Health Commissioner Dr. Jeffrey Howard, citing limited funding and the local reserves that some health departments had, sent $2.2 million in state funds to local health departments and declined to seek an emergency declaration.

Howard and other state health officials have argued the state's overall efforts to stem the outbreak was hobbled more by logistical challenges of reaching drug users than money.

"The Kentucky public should be outraged about the slow-motion public health response that has caused the hepatitis A outbreak to continue into 2019," Brawley said Tuesday.  "I am saddened that 57 Kentuckians have died after developing acute hepatitis A and where hepatitis A was a risk factor for their deaths."

In late March, a legislative measure directing the state to review its response to Kentucky's outbreak failed to pass.

Previously:Review of Kentucky's hepatitis A response gets bipartisan support

Louisville Democrat Rep. Joni Jenkins, who called the state response a "national embarrassment," said lawmakers would continue to pursue the issue with the Cabinet for Health and Family Services. The department has said it plans to review its response.

State health leaders last month said they had hired a roving team of nurses to administer vaccines in rural county jails to help counter the virus. And they said they were providing more vaccine storage equipment, money and expertise to a handful of currently hard-hit counties.

Hepatitis A case rates "continue to decrease across the state, but some counties are still experiencing new cases. As such, the department is continuing to coordinate with local health officials to ensure that resources are available and prevention efforts continue," Howard said in a statement Tuesday.

"We want to reiterate that though cases are declining, this is not a time to be complacent. Rather, we must continue to promote prevention including appropriate hygiene practices and vaccination."

The state health department recently awarded $46,000 to Jessamine, Bell and Christian counties, which requested extra support.

In the Lake Cumberland region, where health department medical director Dr. Christine Weyman said her small staff has been offering vaccinations in jails, food pantries and even college campuses around hard-hit Pulaski County.

Dr. Christine Weyman, Medical Director of the Lake Cumberland District Health Department, talks about how the agency, in collaboration with the Pulaski County Detention Center, has begun offering the hepatitis vaccine to inmates.  About 90 percent of inmates opt to get vaccinated.
March 14, 2019

She said the roving state team was coming to her area next month to help. But she predicted that "it's going to be a while" before cases are snuffed out.  Brawley agreed.

"While the number of reported cases has fallen in recent weeks, I expect that the Kentucky hepatitis A outbreak will continue for at least six more months and will have a total of more than 5,000 cases before the outbreak is declared over," he said.

Reporter Chris Kenning can be reached at ckenning@gannett.com or 502-582-4307.