A statewide hepatitis A outbreak was declared in November 2017. Over the last 15 months the outbreak has become the largest in the nation with 4,288 cases, 2,065 hospitalizations, and 44 deaths from the disease.
To put those numbers in perspective, in 2016 there were about 4,000 cases of hepatitis A reported nation-wide.
Justin Curry, an environmentalist from the Bell County Health Department, shared those statistics and more at Tuesday’s Bell County Fiscal Court meeting.
He explained that when the outbreak started the cases were in central Kentucky, the Louisville area and around Ashland in Boyd County. The number of cases then started to increase in areas along the interstates and is now making its way into more rural areas. While the number of total cases statewide is starting to go down, the disease is on the rise in southeastern Kentucky.
“We’re at the point now where it’s going to start hitting our communities,” Curry said. “Right now Whitley County has the worst prevalence rate in Kentucky. In October they had about 27 cases, one month later it was 81, three weeks later it was 127. According to the latest numbers they’re sitting at 194 now.”
The number of hepatitis A cases reported in Bell County has grown from nine to 40 over the last two weeks.
“The main concern is that it follows a trend. We saw it hit Boyd County and Ashland and from there it worked into Greenup County and then Carter County. So we expect to start seeing an increase in the counties neighboring Whitley,” Curry said.
Another concern is that a 2016 CDC study ranked Bell County 6th nationally on a list of counties that would be most vulnerable to an outbreak of HIV or hepatitis C, which have similar risk factors as hepatitis A.
“Illicit drug use, any sort of homeless population that lacks access to hand washing facilities and a vulnerable group of food service workers are the three main risk factors,” Curry said. “A study done in the late 90s shows that one out of every five food service workers nationally is going to be an illicit drug user. The risk with food service workers is that if they’re infected they could potentially transmit that to others through the food they handle.”
Curry and Bell County Public Health Director Teresa Hunter provided copies of ordinances passed by the Boyd County Fiscal Court and City of Ashland that require food service workers to be vaccinated for hepatitis A and urged the Bell County Fiscal Court to pass a similar ordinance to help slow the disease.
The Health Department has free vaccines available through a grant.
“We’ve got enough that if the ordinance was passed we would be able to cover it,” Curry said. “Private insurance will cover it at no cost to the patient.”
Judge-Executive Albey Brock asked how much the vaccine cost in case the grant was not renewed in the future. He was told each vaccine costs about $55.
“If we pass a local law, it keeps going on. Five years from now a restaurant worker would have to the shot as well,” he said. “We’re talking one in five food service folks are potential drug users, odds are they’re not going to have insurance.”
Hunter said she had spoken to the Boyd County public health director about how things worked there once an ordinance was passed.
“Boyd and Greenup were actually rated near the top of the state and once they did that their rates dropped drastically,” she said. “What their ordinance does is puts the responsibility on the restaurants. They do a voucher system where the employee gets a voucher, they get the shot and then bill the restaurant. Right now we can do it for free and I anticipate the grant continuing while we’re under an outbreak status.”
The ordinance would define food service worker as any person, business or entity engaged in the handling of raw meat and vegetables and/or preparation and service of food and drink to be consumed by the public. That would include restaurants, grocery meat and produce departments, school cafeterias, nursing home kitchens, jails, detention centers and other similar jobs.
Brock asked Hunter if she though the ordinance was something that the Court should pass.
“I don’t want us to be Boyd County or Greenup County. I want to get ahead of this,” she said. “I think we should as a county responsibly. Look, when you’re number six on a list of counties in the nation that are most vulnerable to an outbreak, you need to be serious about it.”
No action was taken by the Fiscal Court at Tuesday’s meeting.
“We will take this under advisement and over the next couple of weeks we’ll talk amongst ourselves and we may adopt one of these or come up with one of our own. We’ll led Neil Ward look into it,” Judge-Executive Albey Brock said “Thank you all very, very much. That was very informative and I appreciate the work you all do keeping us safe.”