Multistate (USA) - Update: Hepatitis A, outbreak declared in SC

May 14, 2019
State Health Agencies

South Carolina

An increasing number of hepatitis A cases in Aiken County and other parts of South Carolina has led the S.C. Department of Health and Environmental Control (DHEC) to define the spread of the disease as a statewide outbreak. 

“Given the steady increase in cases, we determined that South Carolina is experiencing an outbreak,” said Dr. Linda Bell, state epidemiologist and director of the Bureau of Communicable Disease Prevention and Control. “As a result, DHEC is intensifying efforts to control the spread of hepatitis A to avoid a severe outbreak that could threaten the general population.” 

This statewide outbreak coincides with the national hepatitis A outbreak that began in 2016. An outbreak is defined when a disease occurs in greater numbers than expected within a defined area and time period. DHEC previously declared a localized hepatitis A outbreak in Aiken County in February 2019.  

During the past 10 years, South Carolina averaged 19 reported cases of hepatitis A annually. More than four times that amount has been reported in the past seven months. Between Nov. 1, 2018, and May 10, 2019, there have been 86 reported cases of hepatitis A in South Carolina, leading to 59 hospitalizations and one death.  

So far, most cases have occurred in Aiken County, and almost half of all cases involve individuals who report drug use. Certain adults who may be at higher risk for hepatitis A include: 

  • People who use injection or non-injection drugs 
  • People who are homeless 
  • People who are or recently were incarcerated 
  • Men who have sex with men 
  • People with chronic liver disease like cirrhosis, hepatitis B or C   
  • People who are traveling to countries where hepatitis A is common 
  • People with chronic liver disease like cirrhosis, hepatitis B or C as they have an increased risk of complications if infected with hepatitis A 

“We have established a hepatitis A task force that is coordinating efforts to control the spread of the virus by increasing vaccination rates among high-risk groups, establishing partnerships critical to reaching those groups, and conducting outreach and education efforts,” Bell said. 

Additionally, DHEC is currently offering no-cost hepatitis A vaccines to individuals who are drug users, homeless, men who have sex with men or those who have a history of incarceration. Residents can schedule an appointment for a vaccination at their local health department by calling 855-472-3432 or visiting www.scdhec.gov/health/health-public-health-clinics

Florida

From January 1, 2018 through May 11, 2019, 1,677 hepatitis A cases were reported.

The number of reported hepatitis A cases more than doubled from 2016 to 2017 and nearly doubled again in 2018 after remaining relatively stable in previous years. Cases reported in 2019 (as of May 11) are more than two times those reported in 2018 as shown in the figure below by the Florida Department of Health.

Counties that reported a hepatitis A case in week 19 (5/5/19–5/11/19) are outlined in black in the map below by the department of health. Since January 1, 2018, 97% of cases have likely been acquired locally in Florida.

There were 92 hepatitis A cases reported in week 19 (5/5/19–5/11/19). Weekly case counts have steadily increased overall since week 1, 2018.

New Mexico

The New Mexico Department of Health (NMDOH) has confirmed 103 acute hepatitis A virus (HAV) infections with 2 associated deaths in adults ranging in age from 19-64 years in Bernalillo County since the end of October 2018 (see Department of Health Investigates Outbreak of Hepatitis A in Albuquerque).

An acute case of hepatitis A infection has now also been confirmed in Santa Fe County. The current outbreak has primarily impacted people who use both injection and non-injection drugs and people experiencing homelessness.

"Vaccinating people at risk of exposure is the most effective tool we have to prevent the spread of hepatitis A infection during an outbreak," said New Mexico Department of Health Secretary Kathy Kunkel.

NMDOH has provided more than 3700 hepatitis A vaccinations to the at-risk populations in Bernalillo and Santa Fe counties; and is working with community partners to increase awareness and education to help prevent the spread of hepatitis A. Handwashing with soap and water, especially after using the bathroom and before preparing food, plays an important role in preventing the spread of the virus.

Kentucky

In November 2017, the Kentucky Department for Public Health (DPH) identified an outbreak of acute hepatitis A. The increase in cases observed in Kentucky was well over the 10-year average of reported hepatitis A cases.

Several cases have been infected with HAV strains genetically linked to outbreaks in California, Utah and Michigan. Similar to hepatitis A outbreaks in other states, the primary risk factors remain illicit drug use and homelessness. A contaminated food source has not been identified and transmission is believed to be occurring through person-to-person contact.

Counts as of May 4, 2019 (compared to case counts reported on April 27, 2019):

  • Total Outbreak: 4,621 (up from 4,594)
  • Hospitalizations: 2,233 (up from 2,222)
  • Deaths: 57 (up from 53)
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