The Journal-Times reports that the Ashland-Boyd County Kentucky Health Department investigated a case of Hepatitis A diagnosed on May 23 in an employee who worked at McDonald’s Restaurant located at 2550 Winchester Avenue in Ashland, Kentucky.

The investigation found that the risk of restaurant patrons becoming infected was very low. However, McDonald’s is working with the health department to prevent any new cases from arising in the community as a result of this case. All employees, including the diagnosed case, received the Hepatitis A vaccine prior to the May 23 diagnosis. The Winchester Avenue McDonald’s voluntarily closed after notification of the confirmed case to complete extensive disinfection of the facility.

Interesting, the Journal-Times reported that the McDonald’s chain previously established a required hepatitis A vaccination policy for all workers.

This is great, considering a hepatitis A outbreak that has sickened thousands and killed dozens in California, Utah, Michigan, Arizona, Indiana, Kentucky and West Virginia and likely other states, has been brewing for a year.

On May 26 according to WSAZ, a case of hepatitis A was diagnosed in a food worker at the McDonald’s in Grayson, Kentucky. The McDonald’s is located along Carol Malone Boulevard in Grayson.

The Carter County Health Department says all employees at the restaurant received the hepatitis A vaccine before the diagnosis, including the person who was diagnosed. The restaurant closed voluntarily after notification about the diagnosis to sanitize the facility.

The corporate office brought in crews on Saturday, the day of the diagnosis, who disinfected the restaurant. Health officials say the risk of becoming infected if you ate at the restaurant is very low, however, the Carter County Health Department is working with McDonald’s to prevent any new cases from arising.

You have to wonder what the impetus of vaccinating food service workers was?

According to Business Insider, on April 11, 2018 McDonald’s stock dropped on following reports of an investigation of an employee who handled food while infected with hepatitis A. On Thursday, the health department of Madison County, Kentucky, reported it is investigating a single case of hepatitis A linked to an employee working while infectious at a McDonald’s in the town of Berea.

Whatever the motive, great job Ronald.

Do these ladies look like they might have hepatitis A?

According to Live Science, Kentucky Derby fans may need to take some extra precautions before heading off to the races.

The Indiana State Department of Health is recommending that its residents get vaccinated against hepatitis A and take other steps to protect themselves from the illness before traveling to Kentucky or Michigan, both of which are experiencing large outbreaks of the viral infection.

Kentucky has reported more than 300 cases of hepatitis A since November 2017, with 39 new cases reported in the first week of April, according to the Kentucky Department for Public Health. Most cases in the state have occurred around Louisville — the city where the Kentucky Derby is held. The famous horse race, which draws more than 150,000 people each year, takes place on the first Saturday in May.

I remember the first time I traveled outside the US, I got a series of vaccine – including a Hepatitis A vaccine.  I do not recall ever seeing a warning about travel within the US – go figure.

Indiana health officials are advising residents to get vaccinated for hepatitis A if their summer plans include visits to Kentucky or Michigan.

The Department of Health says significant outbreaks of the liver-damaging hepatitis A virus have been reported in Kentucky and Michigan.

The agency says Kentucky has seen more than 300 cases of the highly contagious viral infection, including three deaths, most of those in the Louisville area. Michigan has had more than 800 cases, including 25 deaths.

Indiana typically sees less than 20 hepatitis cases each year, but 77 have been confirmed since January.

State Epidemiologist Pam Pontones says getting vaccinated for hepatitis A and thoroughly washing hands when preparing food are “simple, safe and effective ways” to prevent the spread of hepatitis A.

Likely not so good for tourism?

A vaccine for all employees is good for customers and good for business.

According to a press release, the Madison County Kentucky Health Department is investigating a single case of hepatitis A in a food handler who worked while infectious at McDonalds restaurant on Glades Road in Berea, KY on March 23, 2018. Hepatitis A is caused by a virus that is passed person to person through fecal-oral contact. The risk to patrons who ate at McDonalds is very low. However, individuals who ate there on March 23rd, should watch for signs and symptoms of hepatitis A from April 7th to May 12th.

Hepatitis A can be spread when: an infected person does not wash his or her hands properly after going to the bathroom and then touches objects or food; a caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person; someone engages in certain sexual activities. Hepatitis A can also be spread through food or water through an ill food handler or by using contaminated items.

Symptoms of infection usually appear 15 to 50 days after exposure and can include: fever, jaundice, grey-colored stools, dark urine, abdominal pain, vomiting, fatigue, loss of appetite, nausea and joint pain. Some people, especially children, may have no symptoms. This is why proper handwashing is critical. Symptoms usually resolve in 2 months but can last as long as 6 months. There is no treatment for Hepatitis A and some people require hospitalization. If you have these symptoms you should contact your primary care provider for testing.

Hepatitis A can be prevented by receiving the Hepatitis A vaccination. This vaccination is available to anyone 12 months of age or older and is given in two doses six months apart. Everyone is also reminded that handwashing is the best way to prevent infection. Handwashing should be emphasized especially after using the bathroom, changing a diaper or preparing and eating food.

And, then there is the impact on stock price:

272 with Hepatitis A in Kentucky – Full Report

Employees at two local Louisville, Kentucky businesses have been diagnosed with Hepatitis A.

That has been a similar and common headline in newspapers across the country over the last several months.

One worker at Sarino (1030 Goss Avenue) was diagnosed. Customers who dined at the establishment from February 24 through March 15 may have been exposed to the virus. One worker from Kroger (520 N 35th Street) was diagnosed. Customers who shopped at the store from March 2 through March 19 may have been exposed to the virus.


Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 198 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention 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 Mar. 17, 2018

  • Total Outbreak: 198
  • Hospitalizations: 142
  • Deaths: 1


Since January 1, 2017, Utah public health has identified 226 confirmed cases of hepatitis A virus (HAV) infection; many among persons who are homeless and/or using illicit drugs. Several cases have been linked by investigation and/or viral sequencing to a national outbreak of hepatitis A involving cases in California and Arizona. Hospitalization rates of less than 40% have been described in previous hepatitis A outbreaks; however, other jurisdictions associated with this outbreak are reporting case hospitalization rates approaching 70%.


On Jan. 23, 2018, the San Diego County ended the local health emergency, declared on September 1, 2017, in response to the local hepatitis A outbreak. The action does not mean the outbreak is over, and the County will continue efforts it has taken to control the spread of the disease.  There has been a total of 586 illnesses, 401 hospitalizations and 20 deaths.


Arizona officials believe the local outbreak was mainly confined to homeless people in Maricopa County. The county recorded only 15 known cases and no deaths, and officials have detected no new Arizona cases since the end of May 2017.  The illnesses in Arizona were linked to a person who traveled from San Diego.


Since the beginning of the outbreak in August 2016, the Michigan public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. No common sources of food, beverages, or drugs have been identified as a potential source of infection. Transmission appears to be through direct person-to-person spread and illicit drug use. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate.  There has been a total of 789 illnesses, 635 hospitalizations and 25 deaths.

What about all the rest of the states?  What is the cause?  What is the source?  What can we do – in addition to vaccinations – to stop this?

Ill employee prompts Kroger to vaccinate employees but not customers.

According to Kentucky press reports, an employee in the produce department of the Kroger store at 4915 Dixie Highway has been diagnosed with Hepatitis A.

Kroger said the man worked at the store in Pleasure Ridge Park in February, and customers who bought produce between Feb. 4 to Feb. 28 may have been exposed to the virus. Any produce purchased during that time frame should be thrown away, Kroger said.

The employee worked third shift in the produce section and was diagnosed with Hepatitis A on Feb. 28 at a visit to the doctor. He immediately notified his supervisor, and Kroger notified the Health Department later that day, the company said.

Kroger said officials are cooperating with local and state health officials. Other employees threw away all the produce that the man is believed to have come in contact with and cleaned the store.

Additionally, Kroger is offering all associates and their families Hepatitis A vaccines. About 300 people work at the Pleasure Ridge Park store.

Hepatitis A can be transmitted through eating or drinking contaminated food or water. Symptoms include fatigue, loss of appetite, stomach pain, nausea and jaundice.

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 125 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention 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 Feb. 24, 2018

  • Total Outbreak: 125
  • Hospitalizations: 91
  • Deaths: 0

An employee who worked at the Lancaster restaurant Al-E-Oops and the Brookdale Williamsville Senior Living Facility may have exposed 346 patrons and nursing home residents to hepatitis A. The contagious liver virus can be transmitted through contaminated food and water and close contact with an infected person.

Patrons of the restaurant, located at 5389 Genesee St., and the nursing home, may have been exposed to the virus in late January, announced Erie County Executive Mark C. Poloncarz and Health Commissioner Gale R. Burstein. The food prep employee who worked there tested positive for the hepatitis A virus on Monday.

The county is offering an emergency vaccination clinic on from 3 to 8 p.m. Wednesday at Bowmansville Volunteer Fire Station No. 1, located at 36 Main St. in Bowmansville.

Restaurant patrons who could benefit from either a hepatitis A vaccine or immune globulin injection would have eaten at the restaurant between Jan. 27-30, county officials said. Those who patronized Al-E-Oops between Jan. 16-26 may have been exposed to the disease but would not benefit from an injection. Those who patronized the restaurant after Jan. 30 are at no risk.

Yesterday, the Salt Lake County Board of Health amended Health Regulation #5: Food Sanitation to require hepatitis A vaccination for all food workers in an establishment when anyone working in that establishment has been in contact with someone infected with hepatitis A. This amendment is in response to Salt Lake County’s ongoing hepatitis A outbreak and takes effect immediately, on February 1, 2018.

At least 181 people have been sickened in the Salt Lake area.

“Throughout this outbreak, we’ve identified that some people infected with hepatitis A share a household or are otherwise in contact with someone who works at a food service establishment,” explained Gary Edwards, SLCoHD executive director. “When we’ve learned this, we’ve immediately acted to vaccinate all food workers in that same establishment for the protection of the public. This amendment formalizes and codifies that health department response as it relates to food workers.”

The temporary amendment requires food service establishments to vaccinate all employees who handle food if any worker in the establishment is identified as a contact of someone confirmed to have hepatitis A. Establishments have 14 days to comply with the vaccine requirement; workers who do not comply within 14 days will be excluded from work assignments that involve handling food or food-contact surfaces.

Under the temporary amendment, food establishments are responsible for maintaining official record of their employees’ vaccination status. Each occurrence of an unvaccinated employee handling food or a food-contact surface will be recorded as a critical violation on the establishment’s inspection history, and repeated failure to comply may result in suspension or revocation of the affected food establishment’s permit to operate.

The temporary amendment also authorizes SLCoHD to reduce the cost of the first dose of the hepatitis A vaccine by up to 50 percent for anyone seeking vaccination at a health department immunization clinic who can document that they are a food-service employee in Salt Lake County.

Temporary amendments may be enacted by the Board of Health without the normal public hearing process in response to an imminent public health concern. Temporary amendments are limited to 120 days, during which the Board may, if they choose, engage in the full public notification and hearing process to permanently amend a regulation. The Board has not yet determined if it will be necessary to permanently amend Health Regulation #5.

The Michigan jail system is fighting the spread of hepatitis A in the state’s three largest counties.

The Detroit News reports that thousands of jail inmates in Wayne, Oakland and Macomb counties have opted to receive the hepatitis A vaccine for free in recent months.

A spokeswoman for the Michigan Department of Health and Human Services says the vaccine costs the state $25 per dose.

Health officials say those in jail are particularly vulnerable to hepatitis A because of the close quarters inmates share.

The Health Department says southeast Michigan has had 715 cases of hepatitis A and more than 20 deaths since August 2016. Health officials say the majority of cases are among drug users, homeless people, and current and former inmates.

As I said in a previous post, I have been advocating this fo a very, very long time.  For Goodness Sake, Vaccinate – Against Hepatitis A.

The Detroit Health Department recommends all food establishments get their employees vaccinated.

To support this effort, the Detroit Health Department is launching a mobile vaccination clinic program to provide easy and convenient access for Detroit food establishments to vaccinate their employees.

The Department will set up clinics throughout the City of Detroit, where clusters of restaurants are located.

Restaurants can call the Detroit Health Department at 313-876-0135 to arrange for vaccination.

Southeast Michigan has seen 692 hepatitis A cases, with 564 hospitalizations resulting in 22 deaths in the last year.

Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces, or stool, of an infected person.