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Southwest Virginia has reported some of the state’s highest rates of hepatitis A, according to the Mount Rogers Health District.

The district, which includes Bristol and Washington County, accounts for a quarter of the state’s 205 confirmed cases. Hepatitis A causes inflammation of the liver and is highly contagious, although it can be prevented with a vaccine.

“We’re doing what we can to decrease our numbers,” said Karen Shelton, director of the health district, which also serves Bland, Carroll, Grayson, Smyth and Wythe counties and the city of Galax.

Virginia reported 205 confirmed cases between Jan. 1 and Oct. 17 of this year, according to data from the Virginia Department of Health. Of those cases, 53 came out of the Mount Rogers district. The Cumberland Plateau District near the far southwest corner of the state had 28 cases. None of the state’s 33 other local health districts reported more than 20 cases.

The disease spreads through fecal-oral contact, meaning someone can contract the virus by consuming something contaminated by an infected person’s feces or putting their hands in their mouth after touching a contaminated surface.

People infected with the virus can experience symptoms including fatigue, low appetite, stomach pain, nausea and jaundice. Infections last from a few weeks to months, often requiring hospitalization.

After the hepatitis A vaccine was first introduced in 1996, nationwide rates fell — only 1,390 cases were reported across the country in 2015, according to the Centers for Disease Control and Prevention. But outbreaks started developing in 2016, and federal officials have seen over 27,000 cases in the U.S., including 275 deaths. About 60% of those cases required hospitalization.

Virginia has not reported any deaths, but 125 of the 205 cases (about 61%) led to hospitalization.

Southwest Virginia’s proximity to other states with outbreaks dating back to 2017 and 2018 — Tennessee, Kentucky and West Virginia — may be a contributing factor to the number of cases in this region, Shelton said. Virginia’s outbreak didn’t start until this year.

“Disease doesn’t recognize state or county boundaries or jurisdictions,” said Andrew May, the regional medical director for the Sullivan County Regional Health Department. “It crosses freely between Tennessee and Virginia.”

Since its outbreak started in December 2017, Tennessee has documented 2,621 confirmed cases, including 21 deaths. Consistent with national figures, 61% of the cases required hospitalizations, according to the Tennessee Department of Health. Sullivan County has seen 81 of these cases, according to the state data. The East region — composed of counties surrounding the Knoxville area — leads the state with 574 cases.

Recreational drug users, people experiencing homelessness, currently or recently incarcerated people and men who have sex with men are considered some of the most at-risk groups for hepatitis A.

Officials say a challenge with the disease is trying to determine when and how a person may have been exposed to the virus. It can take 15 to 50 days for symptoms to first appear.

“It’s sometimes hard to pinpoint because the time of exposure is very broad,” Shelton said. “When you try to trace back where you’ve been and what you’ve done, you really have to rely on a lot of history.”

Public health officials are working to make sure high-risk populations have access to the vaccine, which they say is the best way to prevent infection. Although the vaccine has been recommended for all children starting at the age of 1 since 2006, many adults are not vaccinated because they did not receive it when they were younger, according to the CDC.

“We’ve given over 10,000 doses just in Sullivan County alone,” May said about current efforts to combat the outbreak.

Some clinics that did not previously have the vaccine started keeping it on hand due to concerns about the outbreaks.

“We didn’t used to carry the hepatitis A vaccine for adults, but we started carrying it in the last few months,” said Kristin Bresowar, medical director of Southwest Virginia Community Health Systems.

Health officials have also worked to educate restaurants about the risks of hepatitis A and best practices in food preparation, particularly handwashing. Vaccinations have also been administered to people in the food service industry. So far, Shelton estimated her district’s intensive education campaign has reached 400 restaurants.

“Food service workers are not necessarily more likely to get hepatitis A, but if they get it, they are much more likely to spread it to a larger population,” she said.

Prevention efforts may be starting to pay off — both Shelton and May said the rates of cases are starting to decrease. But officials are still cautious.

“It appears to be on the decline for Sullivan County and statewide,” May said. “But I don’t want to count my chickens before they hatch.”

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