Hep A cases soar to 10 times normal in region

Sarah Rahal
The Detroit News

Southeast Michigan is in the midst of a "serious outbreak" of hepatitis A cases, with health departments reporting about 10 times the number Michigan health officials usually see. 

The Michigan health department reports 583 hepatitis A cases and 20 deaths in southeast Michigan since August 2016. Brought into the public eye by an unusual number of restaurant cases, health officials say the majority of cases are among drug users, the homeless and current and former inmates.The majority of the outbreaks occurred in July through October and since then has fluctuated but overall has been declining from the summer peak.

State and public health officials are rallying to contain the outbreak. Health departments have increased awareness efforts by notifying the public and urging vaccination, which imparts lifetime immunity, to prevent the outbreak from spreading.  

"This is extremely unusual. It's about 10 times the amount of our normal cases," said Angela Minicuci, spokeswoman for the state Department of Health and Human Services. "We are dealing with a serious outbreak and our goal is to contain it" and make sure those exposed are vaccinated.

Lt. Gov. Brian Calley announced on Nov. 1 the activation of the State Emergency Operations Center to coordinate the state's response to the outbreak. The Community Health Emergency Coordination Center, a federal government agency which provides emergency community healthcare, also was activated Oct. 31 by the state health department to help in prevention and investigation of cases.

Hepatitis A is a vaccine-preventable disease. If given within two weeks after exposure, the vaccine can prevent the illness. The outbreak, however, comes at a time when there is a limited supply of the vaccine due to a national shortage, health officials say. 

Symptoms include abdominal pain, nausea, vomiting, diarrhea, dark urine, clay-colored stool, fever, chills, yellow skin and eyes (jaundice). Symptoms occur between 15 and 50 days after exposure and can last for several weeks to months.

The virus is usually spread from person to person by consuming something that has been contaminated with the stool of a person with hepatitis A.

Minicuci said there is no particular source of infection in the recent cases, but it is being transferred directly person-to-person and through illicit drug use.

"Those with a history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate," according to the state health department's website.

Hep A can also be spread by infected restaurant workers, which is why health officials spread the word when restaurant cases are discovered.

A food handler could take their phone to the bathroom, properly wash their hands, but get germs on their phone. Food handlers could also be parents and may not wash well after changing a diaper, said Dr. Ruta Sharangpani, the Wayne County health department's medical director. 

The most recent cases in Metro Detroit were reported at Greektown Casino in Detroit on Nov. 30, Andy’s Pizza & Subs on Dec. 1, and Paul's Pizza in Detroit and Papa Romano's on Nine Mile at Telegraph Road in Southfield on Tuesday.

As of Dec. 7, 583 cases have been reported in Michigan, with 482 hospitalizations and 20 deaths linked to the outbreak. Macomb recorded the most cases with 177; Detroit reported 143, with 104 elsewhere in Wayne County and 86 reported in Oakland, according to the state health department

Wayne County typically has two or three cases a year, said Sharangpani.

"It's very unusual to have this large of an outbreak and we don't have an exact pinpoint of where it's coming from," said Sharangpani. "Now that we are seeing it in food handlers, the best way to protect yourself is get vaccinated." The medical director for Macomb's health department said normally they see five to 10 cases a year.

"Of the 177 cases, only five were reported food handlers," said Kevin Lokar, Macomb County medical director.

Nationally, infection rates of hepatitis A in the United States have declined by more than 95 percent since a vaccine for the virus first became available in 1995, according to the Center for Disease Control and Prevention.

However, the number of hepatitis A cases in the United States rose more than 12 percent from 1,239 in 2014 to 1,390 cases in 2015, the latest figures the agency has available. California led the nation in 2015 with 179 cases, followed by Texas with 147 and New York with 123. That year, Michigan had only 21 cases.

Despite the publicity and public fear when hep A is discovered at a restaurant, that's just a small percentage of the problem. Officials say the majority of the cases include drug users, homeless and the inmate population.

Lokar said the majority of Macomb's cases – 87 – were due to substance abuse. Eleven percent represented those who are or were inmates at some point contracting it in prison and 8 percent linked to the homeless population.

Confirmed cases from Aug. 1, 2016 - Dec. 7, 2017.

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Despite the outbreak, Minicuci reassured diners. Generally, those who eat out often should not worry about contracting hepatitis A in restaurants: the cases found in food handlers are a small percentage of the total, said the state's spokeswoman Minicuci.


Twitter: @SarahRahal_