Area health officials are encouraging individuals to get the hepatitis A vaccine due to an outbreak of the disease across the state (please see box).
"Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus," reports Holley Rose, Ripley County Health Department administrator.
It "is passed in the stool, and people become infected by having contact with the stool of an infected person. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not common. Casual contact, as in the usual workplace or school setting, does not spread the virus."
"You see it more in food service settings," RCHD health officer Dr. David Welsh, Batesville, points out. "You can quickly spread it to others, even before you know you're sick .... In the last year, it has gotten more attention as people are more mobile."
Rose reveals the disease's symptoms: diarrhea; nausea; vomiting; tiredness; stomach pain; fever; dark urine; pale, clay-colored stool; joint pain; loss of appetite; and yellowing of skin and eyeballs (jaundice).
"Anyone who has symptoms of hepatitis A should contact a health care provider immediately and should not prepare food for others," noted the Indiana State Department of Health website.
The RCHD administrator reported, "There is no treatment for hepatitis A other than treating symptoms. People who have had hepatitis A develop lifelong immunity and cannot get it again."
"Although the hepatitis A vaccine is recommended for anyone wishing to be protected from the ... virus, it is an Indiana school requirement for all children in grades K-4, 6 and 12 for this current school year .... (It) is a progressive requirement in which all grades will be covered in the next few years. The ... vaccine is encouraged for all ages to prevent illness and outbreak situations locally from the infection."
"Anyone can become ill, but young children, senior adults, pregnant women and immune-suppressed individuals, such as patients on cancer drugs and with organ transplants, are at high risk for illness," she announces.
Others at risk are those who
• Travel to countries where hepatitis A is common and where there is little clean water or proper sewage disposal;
• Drink or swallow untreated water;
• Eat food prepared by an infected person;
• Eat raw produce or raw shellfish;
• Are exposed to the stool or blood of an infected person;
• Work with nonhuman primates;
• Inject drugs; and
• Are homeless because of the risk of injection drug use, poor hygiene and unsafe living conditions.
In general, hepatitis A can be prevented by strictly adhering to these guidelines:
• Get vaccinated for hepatitis A – a two-dose series six months apart;
• Wash hands with soap and water after using the restroom; after swimming; and before, during and after food preparation;
• Wash all produce before eating raw or cooking;
• Use treated water for washing, cooking and drinking;
• Do not change diapers near recreational water; and
• When traveling outside the United States, drink bottled drinks, do not eat uncooked produce unless you peel it yourself, do not eat foods or drinks from street vendors and do not drink or eat local water or ice.
Importance of vaccines
Paul Tyrer, Southeast Indiana Health Clinic, Batesville, manager, stresses, "Protecting yourself with a vaccine is imperative as most of the outbreaks have been by people not taking proper hand wash precautions, and the people being affected were not in the high-risk population for needing a vaccine."
For example, "the exposures that have resulted in people needing a vaccine were mainly food establishments. The customers were recommended (to get) a post-exposure vaccine due to a worker (having hepatitis A). The customers were not in the high-risk population. They were merely patrons of a restaurant.
"Kids who are not vaccinated are also the ones in the workforce being affected. Again, they're not the ones in the high-risk population, but they could be caught up in the exposure.
"In a nutshell, protect yourself as others do not."
Welsh also encourages parents to get their teenagers vaccinated. "These kids are going into the armed forces, to college and into the workforce. They're at risk with whatever life choices they make."
Getting vaccinated "will help prevent the illness, and if enough people get the vaccine, it will help prevent it from spreading. This is called herd immunity."
He also stressed the importance of "remembering the things your mom and grandma told you about washing your hands and having good hygiene."
"Most insurance companies cover vaccinations," Rose reports. "If an individual does not want to bill the vaccine through his/her insurance company, the charge is adults, $65; pediatrics, $30. Uninsured, underinsured and certain high-risk individuals may receive the vaccine at no charge."
The Ripley County Health Department, Versailles, offers both childhood and adult immunizations. Persons can call 812-689-0506 to make appointments or attend one of the monthly walk-in clinics. For this month, they will be held April 3, 11, 18 and 23 from 9 a.m.-3 p.m. and April 29 from 9 a.m.-6 p.m.
Margaret Mary's Occupational Health and Wellness Center also gives the vaccine. To schedule an appointment, call 812-932-5105.
Tyrer emphasizes, "Cost should not be a barrier .... There are no excuses for not getting vaccinated."
For more information about the hepatitis A virus and vaccine, please refer to http://www.cdc.gov/hepatitis/A/index.htm.
Diane Raver can be contacted at diane.raver@batesvilleheraldtribune.com or 812-934-4343, Ext. 114.
Across the state
Since November 2017, the Indiana State Department of Health (ISDH) has been investigating an outbreak of acute hepatitis A virus, according to https://www.in.gov/isdh/27791.htm.
The number of outbreak cases total 1,182. So far there have been four deaths and 619 hospitalizations – about half of all cases. According to the website, "in previous years, Indiana has had an average of 20 cases of hepatitis A per 12-month period."
Forty-three counties have had at least five cases of hepatitis A.
The number of cases as of March 29:
• The most have been reported in Wayne, 142; Marion, 132; and Clark, 82. Other counties with 30 or more reported cases include Allen, Grant, Floyd, Jackson, Jennings, Lawrence, Madison and Monroe.
• 20-30 cases – Fayette, Huntington, Kosciusko and Washington
• 10-19 cases – Bartholomew, Crawford, Dearborn, Delaware, Hamilton, Harrison, Hendricks, Henry, Johnson, Noble, Orange, Shelby, Vanderburgh, Vigo and Whitley
• five to nine cases – Adams, Blackford, DeKalb, Elkhart, Howard, Jefferson, Owen, Randolph, Rush, Scott, St. Joseph, Union and Wabash.
Even though Ripley and Franklin counties are not on this list, "if you look at the map, you will see why I am concerned," Tyrer reports. "We are surrounded by the exposures."
However, the good news is since Jan. 1, 2018, 132,183 vaccines have been administered. Ripley County has had 522 persons vaccinated and Franklin 272.
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