While reported hepatitis A cases are slowing in West Virginia, compared to last summer’s peak, health officials said they won’t declare the outbreak over until cases return to the state’s baseline: three cases per year.
According to the West Virginia Department of Health and Human Resources, there are 2,533 active cases of hepatitis A in the state. Kanawha County leads — as it has since the outbreak began in March 2018 — other counties in the number of cases, with 809 reported in the county limits.
Shannon McBee, the senior epidemiologist overseeing the outbreak, said the hepatitis A outbreak is one of the largest infectious disease outbreaks ever to affect West Virginia, and while it hasn’t been easy to confront the infections, reported cases are down, compared to the peak.
“The response effort to curb this outbreak could not have been accomplished without the support and collaborations between local, state, and federal partners,” McBee said in a statement provided by DHHR spokeswoman Allison Adler. “Cases continue to be detected and investigated by local health departments.”
In the past 63 days, 23 cases have been reported in the state, McBee said, a dramatic drop from the peak of the outbreak, when 100 cases a week were being reported.
Hepatitis A is usually transmitted when someone ingests a small, undetectable amount of an infected person’s stool. In West Virginia, infections connected to the outbreak have disproportionately affected homeless people, as well as IV and non-IV drug users, according to the DHHR’s Office of Epidemiology and Prevention Services.
Fifty-six percent of those infected also have hepatitis C, which also holds high infection rates for people who use drugs.
So far, 23 deaths have been attributed to hepatitis A, nearly half occurring in the past six months.
In December, state health officials said they expected to see the number of cases in Cabell and Kanawha counties peak and begin to decrease. Since the end of December, Kanawha County has seen 27 new cases reported — up from 782 cases then — and Cabell has seen an increase of seven cases, with 271 reported today, compared to 264 then.
Putnam County, lying between Kanawha and Cabell counties, has not seen a newly reported case of hepatitis A since at least Dec. 21, leveling out at 108 infected both then and now, the DHHR said.
However, around that time, as Kanawha and Cabell’s infection rates slowed, other counties’ picked up; namely Wood, Raleigh, Fayette and Wayne.
Wood County holds the third-highest number of reported cases, with 235 today — 68 more than in December 2018. Comparatively, other areas around Wood County are reporting relatively low infections: 50 in Jackson County, 13 in Ritchie County and less than five cases each in Pleasants and Wirt counties.
Carrie Brainard, public information officer at the Mid-Ohio Valley Health Department, in Wood County, said there’s nothing specific to indicate the relatively high, but isolated, number of cases in Wood County.
Issues she cited facing the area — the homeless population and the opioid epidemic — also are facing surrounding counties.
“We do have one of the largest cities here [Parkersburg], and we may have a bit of a transient population; people have family that live here, so they may be visiting from Kanawha,” Brainard said. “There’s nothing to indicate a specific problem we’re having here, though.”
Brainard said the Mid-Ohio Valley Health Department has been working, like many other areas, to provide vaccinations to the most vulnerable populations.
“We go to the homeless shelters, to soup kitchens, to any place that is serving those communities, and we make vaccines available. It’s important to us to, you know, administer the vaccinations, but also make people aware of the problem,” Brainard said. “We have to meet them where they are — and I do, yeah, I think it’s working. I think we’re hitting the right populations.”
Since the outbreak began, more than 43,000 hepatitis A vaccinations have been administered throughout the state, McBee said.
Many local health departments are using similar strategies as the Mid-Ohio Valley Health Department, and several are partnering with community groups — such as Covenant House, in Charleston — to ensure that anyone who can be vaccinated is.
“We’re doing the providing, but we’ve heard at different events — people will come up that have already been vaccinated but they’ll bring a friend and tell them, you know, ‘this is where you get the vaccine, you need to get the vaccine,’ ” Brainard said. “They’re helping us spread the word, too.”
Health departments across the state are still administering hepatitis vaccinations to those who need them, and personnel are available to answer any questions people might have about the disease, Brainard said.
Hepatitis A symptoms can take up to 50 days to show, but can include having a fever, dark urine, clay-colored stool, loss of appetite, the yellowing of the skin and eyes, and joint and abdominal pain.
The best way to prevent hepatitis A is to get the vaccine, and to diligently wash hands after using the bathroom, McBee said.
“That’s what we’re telling people here, all the time: Call us if you need the vaccine or if you have questions, but also — please, this one is the easiest and most important — wash your hands, wash your hands, wash your hands,” Brainard said.