Hepatitis A: how to stay safe during statewide outbreak

In Kentucky, cases of hepatitis A continue to climb. Per year, the commonwealth typically experiences 20 cases of the virus. Since November 2017, that number has grown to over 1,300 reported cases in the state and 50 in northern Kentucky, according to the Northern Kentucky Health Department.

Hepatitis A is a viral infection that affects the liver through the oral contact with fecal matter, according to Rose Tempel, nurse practitioner and interim director of health services at NKU.

“It is, typically, for most healthy people a self-limiting disease, meaning you get sick, you get better—there’s no long-term consequences from it,” Tempel said.

Tempel said symptoms can include nausea, vomiting, fatigue, loss of appetite, fever, abdominal pain and jaundice.

Assistant Biological Sciences Professor Dr. Joseph Mester said symptoms don’t show up for a few weeks once infected.

“When you consume [hepatitis A], most adults don’t have symptoms for the first couple of weeks while the virus is growing in the body,” Mester said. “So it goes through the digestive tract and it invades the blood and then goes to the liver; that’s where it eventually causes symptoms of hepatitis.”

In this time period, Mester said you’re still “shedding,” or spreading the virus without even knowing you’re sick.

“You don’t feel sick but you’re shedding lots of virus, so there’s a chance for the first couple of weeks to really spread it around. Eventually, you do get sick. By that point, you’re not shedding as much virus and most everyone usually recovers,” Mester said.

Once ingested, the virus enters the bloodstream and begins growing in the liver.

“It’s liver tropic—just like the other hepatitis viruses. It just loves to grow and make copies of itself in the liver,” Hester said. “While it does that, it’s coursing through the blood; it stays in your blood.”

The liver drains and eventually hepatitis A leaves the body through stool, according to Mester.

This particular outbreak started in Louisville, according to Adjunct Nursing Professor Jennifer Hunter, who recently retired from the Northern Kentucky Health Department after 28 years. (She served as the director of nursing and clinical services.)

She said it originated among the homeless population, where proper sanitation is poor or nonexistent.

“They all live together…Think about that lack of resources. It spread like wildfire,” Hunter said.

According to the Northern Kentucky Health Department, an employee who handled food at The Newport Syndicate was diagnosed with hepatitis A.

“An investigation found that this employee worked during a period of time when he/she was ill or infectious, which included the dates of July 25 through August 11, 2018,” as stated by their website.

Hepatitis A can live outside the body for over a month, Hunter said, which is why it’s important for restaurants to have good cleaning techniques in place—and staff to oversee it. There are checks and balances to ensure that people preparing and serving food to the public are following guidelines, she added.

Hunter stressed the importance of following proper hand washing techniques, like washing in between fingers, underneath fingernails and in the crevice of the thumb.

“You can wash your hands, but not the right way. And, so, that’s the areas of the hands that you should really pay attention to,” Hunter said.

She also stated the importance of drying your hands after each wash.

“If you have hepatitis A and you wash your hands and you don’t dry your hands and get all that off, you’ve defeated your purpose,” Hunter said. “Because any virus that you have on your hands, hopefully, should go down the sink with the water or when you wipe off with a towel afterwards and you throw that away—it has the virus on it.”

She said hand-dryers work as well, as long as you’re fully drying your hands.

If someone in your household has hepatitis A, Hunter said you need to properly disinfect, citing instructions from the health department.

“It’s not just ‘oh, okay I’m gonna spray some Pledge on something.’ This is what kills it: it’s a one-fourth cup of bleach and a gallon of water,” Hunter said.

Vaccines are another way to protect against the virus; there’s one available that requires a booster six months after the initial dose is administered.

Tempel said doctors recommend anyone over the age of one should get vaccinated.

Anyone can get hepatitis A, but those who have weaker immune systems are at a higher risk, Tempel and Hunter said.

“Diseases know no bounds. Hepatitis A—virus—it doesn’t care who it infects; that’s its job is just to go ‘round infecting,” Hunter said. “It doesn’t matter if you’re male, female, what race you are, what creed you are—it doesn’t discriminate.”

If you’re infected with hepatitis A, it’s important to stay home from work or school.

“You have to stay inside. Don’t expose other people to what you have going on…It has to run its course and you just have to treat the symptoms…Within a week or so, it will run its course, but it just all depends,” Hunter said. “You can be sick for awhile.”