Northeastern Arkansas hepatitis A outbreak unusually severe

LITTLE ROCK, Ark. — An atypical and unusually severe hepatitis A outbreak in northeastern Arkansas has infected at least 85 people and caused at least one death since February, health officials said Tuesday.

In the past week, officials recorded 5 cases of the contagious liver disease in the region. The state typically experiences fewer than 10 cases a year, nearly all of which are imported by international travel, said state epidemiologist Dirk Haselow.

Haselow said that while hepatitis A outbreaks are typically foodborne, this one is associated more with high-risk populations. That includes recreational drug users, homeless and transient populations, people who live in close contact with others and people who engage in high risk sexual behavior.

A typical outbreak involves a particular food item which is contaminated and is ingested by a large amount of people, said Haselow. Officials do not yet know what caused this outbreak.

Health Department spokeswoman Meg Mirvel said children are less likely than adults to experience severe symptoms, which include fever, nausea, fatigue and jaundice.

This particular outbreak is exceptional in its severity, Haselow said. The fatality rate for hepatitis A is typically 0.1 percent, but for this outbreak Haselow said it’s ten times higher.

The state has implemented free vaccinations to inoculate communities which may not already be inoculated or immune.

Mirivel said the department operated two clinics last week which dispensed over 4,400 vaccines. The inoculation is a two-shot series but even with just the first shot, the vaccine is about 94 percent effective, Mirivel said, and protection is thought to be lifelong.

Arkansas’ plan to vaccinate all residents ages 19 to 60 in Greene County is more aggressive than nine other states that are experiencing outbreaks. When infections began a year and a half ago in other states, Haselow said the approach was typical of previous outbreaks. In those cases, officials will reach out to close contacts of an infected individual and recommend vaccination.

But when the cases spread to Arkansas in February, officials realized that approach was ineffective.

Ninety percent of the cases in the past two months have been in Greene County, which has an estimated population of 45,000 people. And while most people older than 60 were likely exposed to the virus as a child, and most children under 18 have already been vaccinated, people between those ages likely have not been immunized.

The state expects to offer clinics until demand decreases, but does not plan for clinics outside of the affected area. The health department also will collect information on vaccination and incidence rate, and share that information with other states.

“The states around us – Missouri, Kentucky and Tennessee – all have way more cases than we do,” Haselow said. “We’d like to say that has something to do with our intervention … but scientifically it’s hard to prove that we’re making a difference at this point. We may just be lucky.”

Haselow said the department has reached out to jails, prisons and homeless shelters in the affected area and provided preventive vaccinations.

The outbreak is far from over, with 3 to 8 new cases are reported each week. Haselow also said the hepatitis A virus is so resilient that regular 70 percent alcohol hand sanitizer may not kill it. He recommended practicing good hygiene, especially hand washing with soap for at least 20 seconds.