According to local press reports, Westchester County has treated 250 people who may have been exposed to hepatitis A at Sleepy Hollow Country Club, officials said today.

Those people received preventive treatment after a club employee was infected by one of the five people who were exposed to hepatitis A at bartaco in Port Chester, said Caren Halbfinger, a spokeswoman for the Westchester Department of Health.

The department is offering free treatment at its clinic at 134 Court St. in White Plains for anyone who ate or drank at the club between Oct. 30 and Nov. 4.

The Health Department will offer hepatitis A vaccine to most people. Infants under 1 year old and people with immune-compromising conditions will be given immune globulin.

The county clinic is providing treatment from 9 a.m. to 4 p.m. today and Tuesday, 9 to 11 a.m. on Wednesday and Thursday, and 9 a.m. to 3 p.m. on Friday. Officials said treatment is most effective within two weeks of exposure.

Phelps Hospital in Sleepy Hollow is offering treatment for anyone who attended its gala at the country club on Nov. 3. Treatment is available at the hospital at 755 N. Broadway from 10 a.m. to 5 p.m. Monday through Friday this week.

Anyone who ate or drank at the club between Oct. 21 and Oct. 29 may also have been exposed, but the treatment is only effective within two weeks of exposure, officials said. Anyone who is too late for treatment is still urged to contact their health care provider immediately, though, so that anyone they may have exposed can receive treatment.

Health officials said they did not expect this outbreak to affect as many as people as bartaco’s outbreak, which included treatment of more than 3,000 people who were potentially exposed to hepatitis A.

Homelessness in the greater Seattle/King County region seems to be rising as fast as High-Tech jobs and housing prices.  There are estimated to be 3,000 people in Seattle each night who are unsheltered and about 10,000 homeless people living on either the streets or in shelters. And, as the nights grow wetter and colder, the lives of our fellow citizens grow even more precarious.  Clearly, homelessness is a complex issue that combines various elements of poverty, substance abuse and mental health, however, now, enters yet another concern – public health – specifically, the growing risk of hepatitis A amongst the homeless, and the risk that it will spread.

It is what is happening in other regions and the risk that it could happen here is real.

In the Detroit, Michigan area there have been 486 cases of hepatitis A, including 19 fatalities, identified as related to an outbreak in Southeast Michigan, according to the Michigan Department of Health and Human Services. In October, health officials said they were investigating cases at Firewater Bar and Grill and a Little Caesars Pizza location in Detroit and a restaurant worker in Ann Arbor. Cases were also linked to Whole Foods in Detroit and Social Kitchen in Birmingham and recently at Champs Rotisserie and Spirits in Wayne County.

In San Diego, California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th, the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.

And, thanks to the Huffington Post, you can see the problem in the whole country:

Hepatitis A is preventable with a vaccine and/or good sanitation and/or handwashing. Hepatitis A is a communicable — or contagious — disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.

Hepatitis A is relatively stable and can survive for several hours on fingertips and hands. It can live up to two months on dry surfaces. The virus can be inactivated by heating to 185 degrees F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. Freezing does not kill the virus.

The vaccine is recommended by public health officials for the following people:

  • Travelers to areas with increased rates of hepatitis A;
  • Men who have sex with men;
  • Injecting and non-injecting drug users;
  • Persons with clotting factor disorders;
  • Persons with chronic liver disease;
  • Persons with occupational risk of infection;
  • Children living in regions of the U.S. with increased rates of hepatitis A; and
  • Household members and other close personal contacts.

So, what can we do to prevent the tragedies that have hit California and Michigan hard and appear to be spreading to other areas of the country?

  • Encourage and offer hepatitis A vaccines to the homeless and other at-risk members of the public;
  • Provide sanitary bathroom and handwashing facilities to the homeless; and
  • Provide assistance to our neighbors to deal with the underlying issues of poverty, substance abuse and mental health.

As I said before – “For Goodness Sake – Vaccinate”

Management of Champs Rotisserie and Spirits at 20515 Mack Ave. alerted the Wayne County Department of Health, Veterans and Community Wellness to the issue.

Hepatitis A is spread through contaminated food or water, or close personal contact with an infected person.

The ill employee is not working and is receiving medical care, the health department said in a news release.

Health officials say those who ate food from the restaurant on or after Oct. 20 should get a vaccine by Nov. 13 if they have not already been vaccinated. People who consumed food from the restaurant Oct. 10-30 should watch for symptoms of hepatitis A, which can include abdominal pain, nausea, vomiting, diarrhea, dark urine, clay colored stool, fever, chills and jaundice. Symptoms occur 15-50 days after exposure and can last for several weeks to months.

Since Aug. 1, 2016, there have been 486 cases of hepatitis A, including 19 fatalities,  identified as related to an outbreak in Southeast Michigan, according to the Michigan Department of Health and Human Services.

In October, health officials said they were investigating cases at Firewater Bar and Grill and a Little Caesars Pizza location in Detroit and a restaurant worker in Ann Arbor. Cases last year were linked to Whole Foods in Detroit and Social Kitchen in Birmingham, and a pizza restaurant in Alabama.

In San Diego California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.

And, thanks to the Huffington Post, you can see the problem in the whole country:

University Christian Church in Hillcrest along with the San Diego County Health Department hosted a breakfast and offered free vaccines Sunday to the homeless and parishioners. Dozens of people took part.

University Christian Church is in the heart of Hillcrest which is considered a major problem area for the epidemic.

“We knew we had to do something. There are so many people affected by this. We also hoped it would build community between our folks and the homeless folks,” said pastor Caleb Lines.

Health officials say immunizing at-risk populations is the best way to stop the spread of the disease, which attacks the liver. The outbreak has killed 18 people and sickened nearly 500 since last November, according to the county Health and Human Services Agency.

The San Diego outbreak was detected in March, and traced back to an origin in November, according to county health officials. A similar strain of the disease has been found in Los Angeles, Orange and Santa Cruz counties.

Michigan press reports that since an outbreak began last August, 376 people in Michigan have contracted the sometimes fatal illness. It’s mainly spread person-to-person via contact with feces.

Angela Minicuci is with the Michigan Department of Health and Human Services.

“We haven’t found one contaminated food source or exposure at this point,” she says, “but we are seeing a lot of relation to people who are using opioids or drugs.”

People who are, or have been incarcerated, are also considered at higher risk of getting hepatitis A, as are homeless people. A staggering 86% of those who’ve gotten hepatitis A in the state since last year have been hospitalized.  Fourteen people have died.

Most of the cases have been in southeast Michigan, including a recent case involving a worker at Cardamom, a popular restaurant in Ann Arbor.

It’s possible people who ate at Cardamom between September 16 and October 3 were exposed.

Minicuci says people with concerns should contact their doctor.

“And from there your health provider can decide if you need that exposure prophylaxis, which is the treatment, or if your best bet is to get vaccinated.”

Hepatitis A can be prevented with a vaccine.  It is now regularly administered to children.

According to the World Health Organization, in developing countries with poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years .

Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare.

In developed countries, children often escape infection in early childhood and reach adulthood without immunity. Ironically, these improved economic and sanitary conditions may lead to an accumulation of adults who have never been infected and who have no immunity. This higher susceptibility in older age groups may lead to higher disease rates and large outbreaks can occur in these communities.

There are now 16 dead with 292 sickened with hepatitis A in San Diego – mostly in the ignored homeless population. And, the numbers of people with this preventable disease is spiking in Colorado (57 ill with 1 death), Michigan (319 ill with 14 deaths), New York (46 ill) and other states and cities (Los Angeles has at least 10 sick, Salt Lake City 21).  Lately, we have also seen the spread to food service workers, potentially exposing hundreds of unsuspecting consumers.

This is all preventable.

In 2006, health officials recommended routine hepatitis A vaccination for all children ages 12-23 months, that hepatitis A vaccination be integrated into the routine childhood vaccination schedule, and that children not vaccinated by two years of age be vaccinated subsequently. The vaccine is also recommended for the following persons:

  • Travelers to areas with increased rates of hepatitis A
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Persons with clotting factor disorders
  • Persons with chronic liver disease
  • Persons with occupational risk of infection
  • Children living in regions of the U.S. with increased rates of hepatitis A
  • Household members and other close personal contacts

The vaccine may also help protect household contacts of those persons infected with hepatitis A. Although generally not a legal requirement at this time, vaccination of food handlers would be expected to substantially diminish the incidence of hepatitis A outbreaks.

Although outbreaks continue to occur in the United States, no one should ever get infected if other preventive measures are taken. For example, food handlers must always wash their hands with soap and water after using the bathroom, changing a diaper, and certainly before preparing food. Food handlers should always wear gloves when handling or preparing ready-to-eat foods, although gloves are not a substitute for good hand washing. Ill food-handlers should be excluded from work.

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water. Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler. The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A. In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states. Six years later, in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant. Other produce, such as blueberries and lettuce, has been associated with hepatitis A outbreaks in the U.S. as well as other developed countries.

HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces. The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. It must be noted, however, that HAV can still be spread from cooked food if it is contaminated after cooking.

So, for Goodness Sake, Vaccinate Against Hepatitis A

The Los Angeles County Department of Public Health (Public Health) warns consumers of possible hepatitis A exposure associated with produce that was possibly contaminated by a worker at a street-side fruit vendor who was infected with Hepatitis A. The fruit vendor was located on the corner of W Ave L and 20th Street West, in Lancaster, CA. Anyone who bought fruit from the vendor’s fruit cart (at this location) during the period of August 15 through August 22 may be at risk for hepatitis A.

The LA County Health Officer recommends that individuals who ate products from a fruit vendor at this location should receive an immune globulin (IG) shot or hepatitis A vaccination within the next week to prevent or reduce illness. Public Health will offer free vaccinations at the Antelope Valley Public Health Center from 8:00 a.m. – 4:30 p.m. beginning, Tuesday, September 5, for anyone who may have been exposed.

Where:

Antelope Valley Public Health Center
335-B East Avenue K6
Lancaster, CA 93535
(661) 471-4860

“We are actively investigating this situation. It is important that anyone who may have bought or consumed fruit from this vendor during the period of August 15 through August 22 should contact their doctor to discuss possible hepatitis A prevention and treatment options,” said Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County. “Those who purchased this product should discard any remaining fruit if still found in their home.”

This new case may be linked to the outbreaks of hepatitis A infections occurring in San Diego and Santa Cruz counties. The large majority of those cases have occurred in persons who are homeless and/or use illicit drugs (injection and non-injection), with several cases also occurring among people who provide services to the homeless. The worker with hepatitis A who worked at the fruit stand had previously spent time in San Diego, has received care, and is no longer infectious.

Public Health has confirmed 3 cases of hepatitis A among high-risk individuals who lived in San Diego during their exposure period as well as 3 secondary cases that have occurred in a health facility in Los Angeles County. Public Health has not identified any new cases associated with the fruit cart.

HAV causes acute liver disease, which may be severe. It is transmitted by contact with the feces of a person who is infected – often through contact with food or water or during sex or other close contact. Signs and symptoms of acute HAV include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than 2 months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination within 2-weeks of exposure or administration of immune globulin. If you experience these symptoms, contact your physician.

Persons who have been vaccinated against hepatitis A or have received IG within the last three months or have ever had laboratory confirmed infection with the hepatitis A virus also do not need an injection of IG.

For more information on Public Health clinics, visit http://publichealth.lacounty.gov/chs/phcenters.htm , or call the LA County Information line at 2-1-1 from any landline or cell phone within the county.

Thanks to HepMag.com for a great summary of ongoing hepatitis A outbreaks going on in the US.

California

Public health officials first detected the hepatitis A outbreak in November 2016 and as of July 21, 2017, 251 cases and 5 deaths have been reported in San Diego. Those affected have largely been homeless individuals, which has made public health efforts more challenging to implement, particularly in reaching individuals with vaccinations and improving hygiene practices. Local officials and community organizations have been working to raise awareness of hepatitis A vaccination, distribute “Hepatitis A Prevention Kits” (containing sanitary supplies), and plans are underway to install hand-washing stations in areas frequented by homeless persons to help stop the spread. Since the outbreak began, the county has administered over 4,000 hepatitis A vaccinations, and more work is planned to expand those efforts. With this combined approach, San Diego is hoping to end the outbreak, the largest in California in nearly 20 years.

Colorado

Between January and early July 2017, 43 cases of hepatitis A were reported in Colorado, a significant increase from 2016 where 23 cases were reported for the full year. Half of these cases resulted in hospitalization and one person has died. Unlike many hepatitis A outbreaks, there is no apparent common link to a restaurant or food item. 74% of hepatitis A cases are men and at least half are men who have sex with men (MSM). Local public health agencies are working to battle the epidemic by targeting MSM with outreach and offering vaccination at a variety of sites.

Michigan

Between August 2016 and June 2017 in southeast Michigan, almost 200 people have been diagnosed with hepatitis A infection, 90% of those infected have required hospitalization, and 10 people have died. Public health officials believe the outbreak to be unrelated to water or food contamination, but rather person-to-person spread through use of illicit drugs, sexual contact, and close proximity. Nearly 50% of those infected report a history of substance use disorders and 20% are also infected with hepatitis C.

According to a Public Health England report, thousands of people in the UK may have been put at risk of contracting Hepatitis E from pork products sold at a leading supermarket which it would not name.

The virus could have infected up to 200,000 people in the UK each year from 2014 to 2014.

By tracing the habits of those infected, the study concluded that only “Supermarket X” was significantly associated with Hepatitis E, in particular own brand sausages. Only pork products from Europe, mainly Holland and Germany, and not the UK carry the strain.

However, sources told the Sunday Times that the supermarket involved was Tesco.

According to the CDC, Hepatitis E is a liver infection caused by the Hepatitis E virus.  Hepatitis E is a self-limited disease that does not result in chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. It is transmitted from ingestion of fecal matter, even in microscopic amounts, and is usually associated with contaminated water supply in countries with poor sanitation. There is currently no FDA-approved vaccine for Hepatitis E.

Hepatitis E is most common in developing countries with inadequate water supply and environmental sanitation. Large hepatitis E epidemics have been reported in Asia, the Middle East, Africa, and Central America.

Most people with Hepatitis E recover completely. During Hepatitis E outbreaks, the overall case-fatality rate is about 1%. However, for pregnant women, Hepatitis E can be a serious illness with mortality reaching 10%–30% in their third trimester of pregnancy. Hepatitis E could also be serious among persons with preexisting chronic liver disease resulting in decompensated liver disease and death.

Vaccinations urged for all people not immune.

According to the San Diego County Health and Human Services Agency, 228 cases of hepatitis A have been reported in 2017, with 161 people hospitalized during the outbreak.  There have been 5 deaths. Public health investigators continue to evaluate cases, but most of those who have become ill are either homeless and/or illicit drug users. Hepatitis A is most commonly spread person-to-person through the fecal-oral route. The disease can be prevented by getting vaccinated. So far, officials said no common food, drink or drug source has been identified as the cause.

In addition, the number of hepatitis A cases over last year in Macomb, Oakland, Wayne and St. Clair counties has increased tenfold, spawning a Michigan Department of Health and Human Services investigation. 190 cases have been reported between August 1, 2016 and June 26, 2017, which has resulted in 10 deaths so far. Officials said it represents a significant health threat, with links to either illicit drug use, sexual activity or close contact among household members.

Symptoms of hepatitis A include jaundice, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools. Symptoms usually appear over several days and last less than two months. However, some people can be ill for as long as six months. Hepatitis A can also sometimes cause liver failure and death.