Hep A cases increasing

A four-fold increase in the number of cases of hepatitis A recently led South Carolina health officials to declare a statewide outbreak and call for stepped up vaccination among at-risk groups.
“We have met the definition of an outbreak in South Carolina based on an increase in the number of cases we’d expect to see in a given time frame,” Dr. Linda Bell, state epidemiologist at the South Carolina Department of Health and Environmental Protection, told The Greenville News.
“This also allows us to take some pro-active measures to prevent the ongoing spread.”
The state typically sees about 19 cases of hepatitis A a year, but has recorded more than four times that number in the past seven months, Bell said.
Of those 86 cases between November 2018 and May 2019, 59 were hospitalized and one died. There are several forms of hepatitis. Hepatitis A is an infection of the liver caused by a virus that’s usually spread via person-to-person contact with someone who has the infection or by consuming contaminated food or water, according to DHEC.
Symptoms usually appear two to six weeks after exposure and include nausea, vomiting, diarrhea, stomach pain, dark urine, loss of appetite and jaundice, which is a yellowing of the eyes and skin, the agency says. Most of those infected feel sick for several weeks and recover without lasting liver damage, but some can be sick for up to six months and some have no symptoms, according to DHEC. Certain groups are at greater risk for contracting the virus, including people who use injection or non-injection drugs, the homeless, those who’ve been recently incarcerated, men who have sex with men, those with a chronic liver disease like cirrhosis or hepatitis B or C, and those who travel to countries where hepatitis A is common, DHEC reports. While most of the 86 cases have been reported in Aiken County, four were reported in Greenville County, three in Spartanburg County and one in Anderson County, Bell said. There were none in Pickens County.
Almost half occurred among people who have used drugs, according to DHEC.
The outbreak has spread gradually over time, with an increase among household members and extended family, Bell said. Vaccination is among the ways to prevent contracting the virus and DHEC is extending its outreach efforts to agencies and organizations that provide services, particularly medical services, to people in high risk groups, including drug rehabilitation facilities, homeless shelters and jails to encourage vaccination, Bell said.
While hepatitis A vaccine is recommended for all children, it is not required for entry into school, Bell said.
Frequent hand-washing with soap and water after using the bathroom or changing a diaper, and before preparing food can also prevent the spread of the virus, DHEC reports.
“The hepatitis A virus is transmitted in conditions where there’s poor hygiene,” Bell said. “So one means of prevention is good hand-washing practices.”
A national outbreak of hepatitis A began in 2016, with more than 17,000 cases and at least 170 deaths in more than two dozen states since, according to the U.S. Centers for Disease Control and Prevention
Infections increased 294 percent from 2013-15 to 2016-18, CDC reports.
DHEC declared a localized hepatitis A outbreak in Aiken County in February.
“It’s important for us to educate people that this is an outbreak, but we are not seeing widespread transmission and we want to prevent that by making sure health care providers are aware of this increase … so they can look for cases and encourage hepatitis A vaccine for prevention,” Bell said.
“If we can increase coverage as quickly as possible, then we can prevent a larger scale outbreak in South Carolina. And that’s our goal.”
Last August, the CDC reported that deaths from liver cancer are up 43 percent nationwide, with South Carolina’s rate higher than the national average. In that case, hepatitis C was cited as the main reason.