shows a microscopic image of a cluster of hepatitis A viruses
An electron micrograph of the Hepatitis A virus (HAV), an RNA virus that can survive up to a month at room temperature. This virus enters an organism by ingestion of water and food contaminated by human feces, and reaches the liver through the bloodstream. HAV infection is endemic in third world countries, and is prevalent in the Far East. Credit: CDC

By Yen Duong

Fourteen months into a widespread outbreak of hepatitis A, Mecklenburg County continues to see new cases of the viral infection.

North Carolina, and Mecklenburg County in particular, is part of a national trend—since 2017, 22 states have reported hepatitis A outbreaks, according to the Centers for Disease Control and Prevention.

Since March 2017, thousands of cases of Hepatitis A have been reported to the CDC. Map credit: CDC.

“We are not seeing the numbers that they are seeing in some of the other states… some of them are seeing numbers in the thousands,” said Dr. Meg Sullivan, medical director of Mecklenburg County Public Health, which has recorded 33 cases and one death since the outbreak began in April 2018. In contrast, Mecklenburg saw only four cases over the previous 14-month period. “We are doing everything we can to prevent that number from getting up to those high numbers.”

Monthly cases of hepatitis A, as reported by Mecklenburg County Public Health. Chart credit: Yen Duong.

Across the country, over 19,000 cases have been identified. About 57 percent of those resulted in hospitalizations and 185 people have died from complications associated with the disease, which is often sexually transmitted but can also be linked to improperly handled food if an infected preparer does not wash their hands.

Last summer, Mecklenburg County Public Health spent two weeks vaccinating 2,056 people who had been exposed to hepatitis A at a Hardee’s when an infected employee didn’t wash up.

The outbreak isn’t limited to the area around Charlotte. Twenty-two other North Carolina counties have reported hepatitis A cases, especially in Wake County and surrounding counties. The state Department of Health and Human Services and Mecklenburg Public Health are working to fight the outbreak with vaccinations and education.

“The best way to prevent hepatitis A is through vaccination,” said state epidemiologist Dr. Zack Moore in a May press release. “North Carolina has the unique opportunity to prevent a large-scale outbreak here by reaching those who are at the highest risk for hepatitis A.”

What is hepatitis A?

Hepatitis A is transmitted when someone ingests infected fecal matter, often via sex or when someone unhygienically prepares food.

“That’s why we talk about the importance of education, so people will know the modes of transmission for HIV and other sexually transmitted diseases,” said Matthew Jenkins, who manages HIV/STD community services for the county health department. “[Hepatitis A] is behavior-driven. A lot of people have the misconception that it’s [only] foodborne.”

Since January 2018, 79 cases of hepatitis A have been reported in North Carolina, according to DHHS. Map credit: Yen Duong.

If someone gets a vaccine within two weeks of exposure, they may not become ill, Sullivan said. The disease attacks the liver and can cause gastrointestinal symptoms such as  nausea, diarrhea and vomiting, as well as jaundice, or yellowing of the skin and eyes.

“There’s not a treatment for it,” Sullivan said. “It’s fluids [and] rest; some people may end up having to be hospitalized. [There’s] not an actual direct medication or antiviral against hepatitis.”

Vaccinations work

Men who have sex with men, people who use drugs, people with chronic liver diseases and people experiencing homelessness or incarceration are at the greatest risk of contracting hepatitis A. Last month, DHHS announced they would start offering the hepatitis A vaccine for free at its three state-operated alcohol and drug abuse treatment centers.

Similarly, Mecklenburg County Public Health is trying to offer the vaccine for free in priority locations, Sullivan said. For instance, health care workers recently administered hepatitis A vaccines at a MedAssist free medication giveaway event.

“We’re trying to raise awareness of it both in the medical community and also in the general public,” Sullivan said. “If we can significantly increase our rates of vaccination, that will go a long way to contain it. I think it’s important, especially in the middle of an outbreak, to raise public awareness and implement some of these measures but not create a culture of fear. Not anyone who walks out the door is going to get hepatitis A.”

In 2005, the CDC started requiring hepatitis immunizations for all children when they turn one. People who have been vaccinated or have already contracted hepatitis A have lifelong immunity to future infections.

“The vaccine is very effective, but the majority of adults haven’t been immunized,” Sullivan said. “This is an example of a disease we have the ability to control through vaccination and infection control measures but we just have to figure out how to do that effectively.”

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Yen Duong

Yen Duong covers health care in Charlotte and the southern Piedmont for North Carolina Health News.