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Published Date: 2018-08-28 12:45:09
Subject: PRO/EDR> Hepatitis A - USA (39): (KY,IN)
Archive Number: 20180828.5992535
HEPATITIS A - USA (39): (KENTUCKY,INDIANA)
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org
In this posting:
[1] Kentucky
[2] Indiana
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[1] Kentucky
Date: Mon 27 Aug 2018
Source: Kentucky Department for Public Health [edited]
https://chfs.ky.gov/agencies/dph/Pages/default.aspx
Since [1 Aug 2017], the Kentucky Department for Public Health (DPH) has identified 1495 cases of acute hepatitis A, a liver disease caused by the hepatitis A virus. An increase in cases since [1 Aug 2017], primarily among homeless people and drug users, prompted declaration of a statewide outbreak in November 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.
The DPH is working closely with the Centers for Disease Control and Prevention (CDC) and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.
Counts as of 18 Aug 2018:
- Total outbreak: 1495
- Hospitalizations: 846
- Deaths: 12
Last updated: 24 Aug 2018
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[Date / Cases / Deaths / Average cases per week
14 Apr 2018 / 352 / 3 / --
28 Apr 2018 / 448 / 4 / 48
25 May 2018 / 629 / 6 / 45
9 Jun 2018 / 832 / 6 / 101
27 Jun 2018 / 969 / 6 / 53
7 Jul 2018 / 1094 / 8 / 87
14 Jul 2018 / 1170 / 8 / 76
21 Jul 2018 / 1221 / 8 / 51
28 Jul 2018 / 1276 / 8 / 55
4 Aug 2018 / 1341 / 8 / 65
11 Aug 2018 / 1425 / 9 / 84
18 Aug 2018 / 1495 / 12 / 70
The cases in Kentucky continue to increase dramatically. The weekly number of new cases reported remains about 50 or more; 70 new cases in the current reporting week.
Those affected the most are the marginalized cohorts of humanity, including homeless people and substance abusers. Their needs for adequate sanitation and living conditions were supplied in the San Diego (CA) area, and such an approach to these outbreaks is required elsewhere in the USA. Spill-over into other portions of the population, such as restaurant diners affected through infected food handlers, will continue. It is not clear how many of these rapidly increasing cases are in individuals outside the described cohorts. - Mod.LL
HealthMap/ProMED map of Kentucky, United States: http://healthmap.org/promed/p/220]
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[2] Indiana
Date: Fri 10 Aug 2018
Source: Indiana State Department of Health [edited]
https://www.in.gov/isdh/27791.htm
Since November 2017, the Indiana State Department of Health (ISDH) has been investigating an outbreak of acute hepatitis A virus (HAV). Cases have been infected with HAV strains genetically linked to outbreaks across the US. Indiana has an average of 20 cases of hepatitis A per 12-month period.
Indiana is one of several states experiencing a hepatitis A outbreak, and outbreak-related cases have been confirmed across the state. Information on other outbreaks can be accessed from the Centers for Disease Control and Prevention (CDC) website [https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm]. Transmission is presumed to occur person to person; no contaminated commercial food product has been identified. Based on CDC guidelines, populations who are homeless, transient, incarcerated, or use illicit drugs and their close direct contacts are considered at increased risk of exposure to hepatitis A.
If you believe you have been exposed to hepatitis A or are homeless, use injection or non-injection drugs, were recently incarcerated, or had contact with someone who has hepatitis A, contact your healthcare provider about the hepatitis A vaccine.
To reduce the risk of hepatitis A transmission, people who have not received 2 doses of hepatitis A vaccine may ask their healthcare providers for protection. Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers, and before preparing meals for yourself and others. Do not attend work or school if you are experiencing symptoms of hepatitis A, which include nausea, vomiting, diarrhea, loss of appetite, tiredness, stomachache, fever, dark-colored (cola) urine, light-colored stool, and jaundice (yellowing of skin and eyes). Symptoms may take as many as 50 days from exposure to appear.
Using the outbreak definition*, the ISDH will update this website each Friday to reflect counties that have 5 or more outbreak-related cases. The ISDH updated the outbreak definition on 20 Jul 2018 and may reflect additional cases that were not included in previous outbreak case counts.
As of 10 Aug 2018: total cases, 414; hospitalized, 180; death, 1.
*Indiana outbreak case definition: confirmed hepatitis A cases (hepatitis A IgM positive with acute symptom onset AND either jaundice OR elevated liver enzymes) acquired since 1 Nov 2017, through person to person transmission within the United States. Cases may be excluded from the outbreak if a confirmed case has no known risk factors (illicit drug use, homelessness, incarceration, men who have sex with men, contact with a confirmed case or domestic travel to an area with a known outbreak), AND has traveled outside of the United States to a country with endemic hepatitis A OR if a confirmed case has a specimen identified as any genotype (laboratory test link) other than 1B.
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[Date / Cases / Hospitalizations (percentage) / Deaths / Average cases per week
11 May 2018 / 94 / 46 (49) / 0 / --
6 Jul 2018 / 202 / 93 (46) / 0 / 13.5
13 Jul 2018 / 220 / 101 (46) / 1 / 18
27 Jul 2018 / 298 / 136 (46) / 1 / 39
10 Aug 2018 / 364 / 161 (44) / 1 / 33
24 Aug 2018 / 414 / 180 (43) / 1 / 25
- Mod.LL
HealthMap/ProMED map of Indiana, United States: http://healthmap.org/promed/p/217]
See Also
Hepatitis A - USA (38): (WV) 20180827.5990109Hepatitis A - USA (37): (KY) 20180821.5978468
Hepatitis A - USA (36): (KY, OH, IN) 20180818.5969602
Hepatitis A - USA (35): (KY, TN, IN) 20180812.5960616
Hepatitis A - USA (34): (KY, AR) 20180808.5952232
Hepatitis A - USA (33) 20180806.5949411
Hepatitis A - USA (32): (KY) 20180731.5939498
Hepatitis A - USA (31): (KY, WV, IN) 20180728.5933912
Hepatitis A - USA (30): (WV, AR) 20180714.5905424
Hepatitis A - USA (29): (KY, IN) 20180713.5903435
Hepatitis A - USA (28) 20180709.5895266
Hepatitis A - USA (27): (WV, UT, MI) 20180702.5885159
Hepatitis A - USA (26): (KY, TN, NC) 20180628.5880740
Hepatitis A - USA (25): (OH) 20180625.5873183
Hepatitis A - USA (24): (KY, TN, MO) 20180621.5860894
Hepatitis A - USA (23): CDC Health Alert Network 20180615.5856421
Hepatitis A - USA (22): (KY, NC) 20180608.5844690
Hepatitis A - USA (21): update 20180531.5830692
Hepatitis A - USA (20): (KY, TN) 20180527.5820929
Hepatitis A - USA (19): (MI, UT, IN) 20180518.5798559
Hepatitis A - USA (18): (MI, UT, KY) 20180512.5792086
Hepatitis A - USA (17) 20180509.5789924
Hepatitis A - USA (16): (AR, KY, IN) 20180503.5780360
Hepatitis A - USA (15): (OH, MI) 20180425.5769100
Hepatitis A - USA (14): (KY, WV, UT) 20180424.5762837
Hepatitis A - USA (13): (UT, MI) 20180406.5729135
Hepatitis A - USA (12): (MI, UT, IN) 20180328.5716201
Hepatitis A - USA (11): (KY, IN) 20180318.5694916
Hepatitis A - USA (10): (KY, UT, MI) 20180307.5671905
Hepatitis A - USA (09): (KY, UT, MI) 20180222.5645053
Hepatitis A - USA (08): (WY) 20180216.5632464
Hepatitis A - USA (07): (CA, UT, MI) 20180215.5629167
Hepatitis A - USA (06): (CA) 20180208.5615970
Hepatitis A - USA (05): (MI, UT, CA) 20180128.5589100
Hepatitis A - USA (04): (MI, KY) 20180115.5559179
Hepatitis A - USA (03): (UT) 20180111.5552496
Hepatitis A - USA (02): (CA, MI, UT) 20180108.5544747
Hepatitis A - USA: (HI) 20180107.5543399
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