Louisville's hepatitis A outbreak: Cases spread to Indiana and now some schools are closed
An outbreak of hepatitis A in Kentucky, centered in Jefferson County, has spread to more than 100 people — a significant increase in a state that typically sees about 20 cases per year.
Confirmed cases have continued to grow since the outbreak was declared in November when there were 19 cases in Louisville. At the time, officials said common risk factors included homelessness or drug use.
Since then, at least two employees in the food service industry have been added to the city's list of victims and more than 20 cases identified in Southern Indiana prompted the closure of at least one school district's campus — which includes three Henryville schools.
Here's what you need to know about the virus:
There are more than 140 cases in Louisville
Jefferson County is ground zero for the highly contagious liver infection, with more than 130 of the state's cases and the first death linked to the virus.
There are typically four or fewer Louisville cases of hepatitis A in an entire year, according to a spokesman for the Louisville Metro Department of Public Health. But officials said Friday there are 143 confirmed cases in Jefferson County, up from 120 the week before — and it's possible the outbreak still may not have crested.
The city health spokesman, Dave Langdon, told Courier Journal more than 5,700 people, mostly those considered at highest risk, have been vaccinated across the city since the outbreak began late last year.
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It spread across the river to Indiana
Clark County's health officer Dr. Eric Yazel said Friday the county has 25 hepatitis A cases, with two more that are pending.
Of those, most have been connected to the Louisville outbreak, which makes sense given the "migration of population" between the two regions, Yazel said.
"It's almost like one big general outbreak in Kentuckiana," he said, adding that the county is treating the number of cases with the highest level of precaution.
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Several cases were confirmed among jail inmates, as well as among two workers at Henryville Elementary School, the health department announced on Thursday.
West Clark Community Schools' Henryville campus was closed Friday as a health precaution, the district said. That campus includes Henryville's elementary school and junior and senior high schools. School is expected to resume as scheduled Monday, according to a letter sent home by the district.
Health officials have focused on vaccinating targeted populations, primarily people living in close quarters like in a jail or at a homeless shelter, Yazel said. Since the first cases began to appear in early December, more than 500 vaccinations have been administered in Clark County.
Yazel recommends anyone who interacts with a large amount of people, such as those in the food industry, to get vaccinated. And anyone with symptoms is advised to stay home to prevent spreading the virus.
Floyd County did not immediately respond to a request for comment on Friday.
Since November of 2017, Indiana has confirmed 37 cases statewide, a spokeswoman for the Indiana Department of Health said on Friday. Of those, 14 people reported visiting Kentucky before their illness onset, spokeswoman Megan Wade-Taxter wrote in an email.
The hepatitis A cases in the Clark County jail were considered to be an outbreak, she said, but there has not been an outbreak declared for Clark County or Indiana.
Across the country, outbreaks have been identified in California, Michigan, Wyoming and Utah.
Some cases have been identified in the food service industry
An employee at the Kroger store on Dixie Highway was diagnosed earlier this month, prompting an alert from the store warning customers to look out for possible symptoms.
Roughly a week later, city health officials said a former employee of the Denny's restaurant in St. Matthews had also been diagnosed, after having potentially exposed customers to the virus.
A news release from the city last week advised that people can become ill two to six weeks after being exposed to the virus.
Symptoms include vomiting and a fever
The disease, caused by a virus, tends to hit adults hardest.
According to Dr. Lori Caloia, the city health department's medical director, common symptoms include:
- yellowing of the skin and whites of the eyes
- fever and body aches
- stomach pain, nausea and vomiting
- darker urine and lighter-colored stools
Symptoms usually last less than two months, but between 10 and 15 percent of victims remain sick for up to six months, according to the Centers for Disease Control and Prevention.
This isn't the city's first time dealing with an outbreak
An outbreak tore through the Louisville area in 1988, killing one and infecting more than 200 others.
One victim, Rick Hancock, remembered several weeks of vomiting that left him exhausted and dehydrated. At one point, he couldn't even drink water.
"I can remember laying there in my bed when I was sickest, thinking, 'Gosh, I'm glad I don't have a gun in this house,'" he said.
A study of the outbreak published in the American Journal of Public Health in 1990 found that in nearly three out of every four cases, the victims ate at one of three Louisville restaurants. It did not identify the eateries.
The outbreak was later traced back to produce that had been contaminated before it was distributed to restaurants — the first known contamination of its kind in the United States, the report stated. All of those restaurants had purchased produce from the same distributors.
Hancock's illness was seven years before a vaccine for the liver virus was made available in 1995, according to Dr. Paul Schulz, an infectious diseases specialist and system epidemiologist for Norton Healthcare.
Louisville officials urge people to consider getting the vaccine, which is covered by most insurance plans and offered at Kroger and Walgreen pharmacies.
Reporter Beth Warren contributed to this report.
Darcy Costello: 502-582-4834; dcostello@courier-journal.com; Twitter: @dctello. Support strong local journalism by subscribing today: www.courier-journal.com/darcyc.