CLEVELAND, Ohio -- Ohio should brace for a second year of a hepatitis A outbreak that has killed seven Ohioans and hospitalized more than 1,000 since 2018, health officials said recently.
The state declared a hepatitis A outbreak in June 2018 when it saw the number of cases rise to 79, which is nearly double the yearly average, said Sietske de Fijter, state epidemiologist with the Ohio Department of Health. State workers have tracked about 2,000 hepatitis A cases since the start of 2018.
Cuyahoga County has seen about 30 cases during that time.
Outbreaks of hepatitis A, an infectious disease that attacks the liver, commonly last about two years. While there are hints that the current outbreak may be slowing, the illness will probably continue to spread, de Fijter said.
Hepatitis A spreads when people ingest food or water contaminated with small particles of infected fecal matter. It also can be spread by close contact with an infected person or object.
The illness causes fatigue, low appetite, stomach pain, nausea, clay-colored stools and jaundice. A mild case can end in a few weeks; a severe case can last several months.
The current hepatitis A outbreak is at its worst in southwest Ohio, where there are many intravenous drug users who are at risk of contracting the illness, de Fijter said. The highest number of cases in Ohio is found in Franklin County, which tracked 300 cases since the start of the outbreak, followed by Butler County with just under 300 and Montgomery County with about 200.
Health officials in that part of the state are seeing patients with underlying conditions who tend to be hospitalized if they also get hepatitis A, she said.
In southwest Ohio, public health departments are taking steps to reach at-risk individuals and get them vaccinated.
Hamilton County Public Health operates The Exchange Project, a comprehensive infection prevention program targeted at people who inject drugs. The program offers hepatitis A vaccination and disease testing along with treatment referrals, Narcan distribution and needle exchange.
Hamilton County also vaccinates county inmates and food service employees who may have been exposed to hepatitis A through food-related exposures, county officials said.
Dayton and Montgomery County Public Health’s incident management team holds vaccination clinics targeting the county jail, the homeless, men who have sex with men and illegal drug users. Cuyahoga County doesn’t have any specific outreach programs, but may start one later this year, a spokesman said.
Individuals who are at risk for contracting the illness includes people who are homeless, in jail or recently released from jail, illegal drug users, and men who have sex with men. People who come in direct contact with someone who has the illness, and those who have traveled to regions of the world where hepatitis A outbreaks are occurring, also are at risk.
There is an effective vaccine for hepatitis A, but it was recommended only for children when it became available in the 1990s, leaving many adults unprotected, de Fijter said.
Now doctors recommend everyone over age 1 get the two-dose vaccine, given six months apart.
A single dose conveys 93% effectiveness that lasts 11 years. “Getting the first shot to anybody at risk is very effective,” de Fijter said.
Most new cases are among the homeless or intravenous drug users. Mistrust of the government runs high in the homeless community, making it difficult to spread vaccination information there. “It may take multiple times to reach out and build rapport,” she said.
Vaccines are available from health departments, outreach clinics and health care providers across the state. Click here for a “find a local health department” link.
“Vaccination is the best method to prevent disease,” de Fijter said.
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