How local hospitals are combating spike in Hepatitis A

Local hospitals are working with county health departments to combat a dramatic surge in cases of Hepatitis A.

The vaccine-preventable, communicable disease of the liver is caused by the hepatitis A virus. It’s usually transmitted person-to-person through contact with an infected person’s stool, or consumption of contaminated food or water. It can also spread from close personal contact with someone who is infected, such as through sex.

Butler and Montgomery counties had 62 and 81 cases, respectively, as of Sept. 24, according to the Ohio Department of Health. Numbers of outbreak-linked cases have swelled to 127 and 118 cases, respectively, through Oct. 22, outpacing nearby Hamilton (77), Clermont (15) and Warren counties (4).

FIRST REPORT: Hepatitis A cases surge in two area counties

Montgomery and Butler are the only counties with more than 100 cases so far this year, but the outbreak is statewide. There have been 717 cases recorded in 54 of Ohio’s counties this year, as of Oct. 22. resulting in 451 hospitalizations (63 percent) and 1 death, which was reported earlier this month in Montgomery County.

For comparison, the median number of annual cases from 2012 to 2016 was 38, according to the Ohio Department of Health.

Fort Hamilton Hospital has diagnosed 79 patients with Hepatitis A, according to the most recent data from the Butler County General Health District.

“Fort Hamilton Hospital has been working with the Butler County General Health District in reporting volumes, pertinent transmission and presentation data for outbreak investigational purposes,” said Erika Sanso, director of clinical quality. “We are actively screening patients presenting with symptoms.”

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Extensive education is being provided for patients with the diagnosis including the urgent need to vaccinate with the two doses over six months Hepatitis A vaccination series and community resources where vaccination is possible, she said.

Symptoms include nausea, vomiting, diarrhea, abdominal pain, fatigue, low appetite, fever, headache, jaundice and elevated liver levels. Most affected feel sick for several months, recover and do not have lasting liver damage.

Those with symptoms of Hepatitis A should visit a primary care physician, local health center or local health department for assessment, testing and treatment as applicable, Sanso said.

“We strongly urge, as does the Butler County General Health District and Centers for Disease Control, for individuals at high-risk or have frequent direct contact with individuals at high risk to get the two-part Hepatitis A vaccination series,” she said.

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Mercy Health’s five Cincinnati-area hospitals in 2017 reported three Hepatitis A cases to the local public health departments, according to Janet Miller, Mercy Health regional manager of infection prevention.

To date for 2018, Mercy Health-Cincinnati hospitals have reported 58 cases of Hepatitis A to the local public health departments, Miller said.

“Mercy Health cares for Hepatitis A patients using our current practice of standard precautions for all patient encounters,” she said. “Standard precautions protect staff from unprotected exposure to blood and body fluids and potentially infectious microorganisms.”

Area health departments are working to make Hepatitis A vaccine more widely available to those hardest hit by the epidemic, according to Dr. Carl Fichtenbaum of the Division of Infectious Diseases in the Department of Internal Medicine at the UC College of Medicine.

“This means getting it to clinics, places that serve the homeless, substance abusers and for contacts of food service workers among others,” Fichtenbaum said.

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The number of Hepatitis A cases started to rise in the spring, and a statewide outbreak was declared this summer. Neighboring states such as Indiana, Kentucky and Michigan have all been affected by a Hepatitis A outbreak.

Fichtenbaum said not everyone in the Cincinnati area needs a Hepatitis A vaccine.

“Avoid eating out in restaurants that have been associated with epidemic transmission,” he said. “Good hand washing is important after using the restroom by everyone.”

Those who do have Hepatitis A, should not cook or prepare food for anyone else and should use “very, very good hand washing hygiene,” Fichtenbaum said.

TriHealth, which includes McCullough-Hyde Memorial Hospital in Oxford, is employing heightened surveillance for cases with testing of high-risk groups by its emergency doctors and physician groups and vaccination of high risk groups by its physicians, according to Dr. Stephen Blatt, TriHealth’s medical director for infectious diseases.

It’s also working with the Butler County General Health District officials to identify and report cases promptly “so that contact investigations can begin to identify contact persons for vaccination or prophylaxis” and then carry out those measures in active cases of acute Hepatitis A, Blatt said.

Hepatitis A cases by facility of diagnosis*

Fort Hamilton: 79

TriHealth Bethesda Butler/North Hospitals: 47

Other (jail, VA, urgent cares, private physician): 20

Mercy Health Fairfield/West hospitals: 17

Rehabilitation center (e.g. Sojourner): 11

West Chester Hospital: 7

Atrium Medical Center: 5

Other regional hospitals: 5


Hepatitis A cases by city of residence*

Hamilton: 139

Fairfield Twp.: 14

Fairfield: 11

Middletown: 10

Trenton: 5

West Chester: 3

Liberty Twp.: 2

Other Areas in Butler County: 7

* — all reported cases, including non-hospitalization

SOURCE: Butler County General Health District

Who is at greater risk for Hepatitis A?

  • People who use street drugs whether they are injected or not
  • People who are incarcerated
  • People experiencing homelessness
  • Men who have sex with men
  • People with direct contact with individuals infected with the virus
  • People who have traveled to other areas of the U.S. currently experiencing outbreaks

SOURCE: Ohio Department of Health

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