Hep A infections surging toward epidemic levels

Dr. Aisha Thomas-St Cyr [Photo: Denise Ritchie]

Florida has declared a public health emergency over the rising number of Hepatitis A cases in the state.

Up north, the city of Philadelphia has done the same thing, while the Minnesota Department of Health has declared an official “outbreak” of the disease in multiple counties, and states like Ohio, Kentucky and West Virginia seem poised to do likewise.

What is going on? Why all the fuss?

After all, the disease is not typically fatal. The Centers for Disease Control says most people who contract Hep A will have flu-like symptoms including “fatigue, low appetite, stomach pain, nausea and, in extreme cases, jaundice,” but it also says those symptoms “usually resolve within two months of infection.”

The key words there are “most people.”

For those with existing liver problems. Hepatitis A can hit much harder and sometimes be fatal.

Knowing how the infection spreads is not pleasant either.

While the Harvard Medical School politely tries to explain the transmission of the Hep A virus by saying these infections “most often occurs from the ingestion of contaminated food,” that’s actually a super-sugar-coated version of what happens.

In simple terms, the primary way the Hep A virus is spread is by ingesting traces of human fecal matter.

Infectious disease specialist Dr. Aisha Thomas-St. Cyr with Steward Health Care’s Sebastian River Medical Center confirms that less-than-appetizing prospect.

Hep A, she says matter-of-factly, “is fecal-oral transmission. The other hepatitis viruses [B, C, D and E) might be blood-borne or mother-to-child or in other ways, but this one is fecal-oral.”

In practice they usually means Hep A spreads because people do not wash their hands after using the toilet and then handle food or put their hands in their mouths, and because of sexual activity. The virus can also be spread when someone with contaminated hands touches a surface or object such as a counter or cellphone and someone else then touches the same thing and somehow transfers the germ to their mouth.

Worse, this highly contagious virus has also been spreading rapidly.

As recently as 2015, fewer than 1,400 cases were reported nationwide. But by 2018, Florida alone had 528 cases of Hep A, and so far this year nearly 2,200 infections have been reported in the Sunshine State. The numbers in Minnesota, Kentucky, Ohio, West Virginia and as many as 18 other states are also beginning to skyrocket.

So far, Indian River County has not been hit too hard, with just five cases reported, according the state health department, but neighboring counties are seeing larger numbers, with 77 infections in Brevard County and 32 in St. Lucie County.

“It has definitely quadrupled what it usually is,” says Thomas-St. Cyr of the statewide outbreak.

The level of infection in Florida has not reached the CDC’s technical definition of an epidemic, but Thomas-St. Cyr strongly advises getting the Hep A vaccine because “unfortunately, it’s already becoming an epidemic in certain counties.”

Insurance coverages vary on the Hep A vaccine, though Medicare will pick up the tab for its enrollees and the vaccines are in good supply, according to Thomas-St. Cyr. She adds that in Florida, “a lot of the [county] health departments are giving free vaccines.”

In this part of the state many of the new Hep A cases have been linked to restaurant workers failing to wash their hands thoroughly after using the toilet, though Thomas-St. Cyr also cautions that “anal-oral sex is also a very huge factor.”

And if you thought the Hep A story couldn’t get much worse after reading that, you’d be wrong.

“These viruses,” Thomas-St. Cyr reports, “are hearty. They can live out of the body on surfaces for months,” and remain fully capable of infecting you that whole time.

And the vaccines? According to the CDC, “if you were recently exposed to the hepatitis A virus and have not been vaccinated, you might benefit from getting the hepatitis A vaccine.”

But you might not.

The CDC also says “the vaccine is only effective if given within the first two weeks after exposure,” and if you were exposed while out to dinner last month, the best you can really hope for are merely mild flu-like symptoms as it runs its course.

If you start to feel those flu-like symptoms coming on, you should probably contact your primary care provider and let him or her help chart a safe course for you, your liver and your life.

Given the burgeoning numbers of Hep A cases being reported, getting the vaccine before you’re infected should be job one, according to Thomas-St. Cyr.

Dr. Aisha Thomas-St. Cyr is an infectious disease specialist at Sebastian ID Care at 7955 Bay Street, Suite 2 directly south of the Sebastian River Medical Center. The phone number is 772-388-9155.

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