An outbreak of Hepatitis A continues to spread across portions of southeast Missouri and is starting to make its way to more populated areas.
The outbreak was first identified in September 2017, but as of July 23, 2019, there have been 378 confirmed cases throughout 33 Missouri Counties. Some of the hardest hit include Butler, Howell and, more recently, Franklin counties.
Rachael Hahn is the Chief for the Bureau of Communicable Disease Control and Prevention at the Missouri Department of Health and Senior Services. She said those most affected have been people who are homeless, use illicit drugs or have close contact with people who may be using drugs.
“Sixty-four percent either reported illicit drug or tested positive, so it’s likely that is an underestimate,” Hahn said.
This year, the outbreak has begun to spread beyond the Missouri Bootheel, which is where it had been centered, to more populated areas.
“There’s a possibility that we could have a really hard time dealing with a very large-scale outbreak,” Hahn said. “So, that's something that we've been working to try to avoid, and we hope it doesn't happen.”
She said DHSS has been working with the larger health departments in Greene County, the St. Louis metro area and Kansas City to reach and educate the most at-risk population before cases begin to show up. Once cases are seen, efforts need to be more focused on contact investigations.
“And we're doing our best to help protect the health of the individual and the population centers,” Hahn said. “Not because they're more important than rural areas, of course, but just because there's a lot of possibility that we could see the scale of this get out of hand very quickly.”
The investigations identify people who have been in contact with others testing positive for Hepatitis A.
This is an important part of outbreak management because while Hepatitis A is similar to its better-known siblings, Hepatitis B and C, the transmission method is different.
All of the viruses cause inflammation of the liver, but Hepatitis B and C are transmitted by bodily fluids like blood through intravenous drug use or shared needles, and Hepatitis A is transmitted when tiny fecal matter particles on someone’s hand get on shared objects and are inadvertently consumed.
In an email, Hahn wrote that more than $700 thousand from the Centers for Disease Control and Prevention has been used or reserved for vaccines, prevention outreach and contact investigations. The CDC is working to combat Hepatitis A outbreaks in several states.
Hahn added 14,717 outbreak related doses of vaccine have been administered and a little more than 9,000 additional doses of vaccine have been sent out.
While vaccination is the most effective way to not get Hepatitis A, state and federal officials stress the importance of another preventive measure: hand washing.