Canada FluWatch Week 45: Early Flu Affecting Younger Age Groups

Credit PHAC

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While the latest (week 45) FluView report from the United States continues to show only low levels of influenza activity across the country, yesterday we saw South Korea declare an early start to their flu season, and today we have the latest FluWatch report from Canada indicating an early arrival of flu activity as well.

Unlike our horrific H3N2 flu season last year - which saw 80,000 deaths in the United States alone - so far H1N1 seems to be the dominant flu strain this fall.  While H1N1flu seasons tend to be milder than H3N2 years, this subtype does tend to exact a heavier toll on younger age groups. 

And while the flu season is just getting started in Canada, already they are reporting a significantly higher number of pediatric hospitalizations than usual, and early evidence suggests younger patients are being more affected than recent years.

FluWatch report: November 4, 2018 to November 10, 2018 (Week 45)

Overall Summary

• Influenza activity continued to increase in week 45. The influenza season has started earlier than in recent years.The number of regions in Canada reporting sporadic or localized influenza activity in week 45 increased slightly compared to the previous week.
• Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
• The number of influenza-associated hospitalizations continued to increase in week 45. In particular, the number of pediatric hospitalizations is significantly higher than in recent years.
• The number of influenza outbreaks remains within expected levels. However, the settings in which outbreaks have been reported this season suggests that younger age-groups are being affected more than in previous seasons.

Laboratory Confirmed Influenza Detections

In week 45, the following results were reported from sentinel laboratories across Canada (Figure 2):

• The percentage of tests positive for influenza continued to increase to 9.6% of tests positive.
• The percentage of tests positive for influenza A is higher for this time of year compared to the same period during the previous eight seasons. Laboratory detections of influenza have entered seasonal levels three weeks earlier than the median over the previous eight seasons.
• In week 45, 509 laboratory detections of influenza were reported, of which 97% were influenza A.

To date this season 1,523 laboratory-confirmed influenza detections have been reported (Figure 3):

• 97% have been influenza A
• Among the 922 influenza A viruses subtyped, 80% have been A(H1N1)pdm09

To date this season, detailed information on age and type/subtype has been received for 1,457 laboratory-confirmed influenza cases (Table 1):

• Adults 20-44 years of age represent the largest proportion of cases (25%), followed by adults >65 years of age (20%).

For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.

        (Continue . . . )

The good news here, at least compared to last year, is that the H1N1 component of the flu vaccine is generally more effective than its protection against H3N2.  And after two difficult H3N2 seasons, this year may prove more manageable.

But H1N1 is far from benign, and it tends to hit children and younger adults harder than H3N2.

While flu activity is remains low in the United States, yesterday's FluView report does show the start of some activity, particularly in the deep south (see map below).  

  

With the first big cold snap for the south land this week, a big winter storm in the northeast, and next week's Thanksgiving travel and intermixing, the conditions are ripe for flu to ramp up over the coming weeks. 

If you haven't gotten your flu vaccine, now is the time to get it, as it takes a couple of weeks for the shot to take full effect.

And whether you get the flu shot or not, now is also the time to start consistently practicing good flu hygiene (covering coughs, washing hands, staying home if you are sick, etc.).

China MOA: ASF Reaches Shanghai - New Outbreaks In Sichuan, Yunnan & Jiangxi

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African Swine Fever continues to spread in China, and for the fifth time in 10 days, a new administrative district (today it's Shanghai) has reported their first outbreak. Yesterday it was Sichuan Province, 9 days ago it was Jiangxi & Fujian Provinces, and 10 days ago it was Hubei province.  

It total, 19 of China's 34 administrative districts have reported ASF outbreaks since August 1st.

While African Swine Fever poses no direct threat to human health it is a devastating disease for pigs, and with no vaccine, the only recourse is to destroy all infected and potentially exposed pigs.

China, as the both the world's largest producer and consumer of pork, faces huge economic and societal challenges if ASF cannot be contained, and has recently announced hard-line measures in an attempt to do so.

Last weekend the big ASF headline was the ASF Virus Was Detected In Commercial Animal Feed, but subsequent testing has reportedly cast some doubts on those initial reports. 

Potentially good news, but that still leaves big questions over how the virus has been spread so rapidly, and so widely, across the eastern half of China.

Two (translated) reports from the MOA this morning:

Shanghai Jinshan District to detect African swine fever
 
Date: 2018-11-17 18:06 Author: Source: Department of Agriculture Office of Rural room 

The Information Office of the Ministry of Agriculture and Rural Affairs was released on November 17, and the Jinshan District of Shanghai Province detected the African swine fever epidemic.

At 16:00 on November 17, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Disease Prevention and Control Center and was diagnosed by the China Center for Animal Health and Epidemiology (National Center for Animal Disease Research). Pig plague. 

Up to now, the farmer has 314 pigs, 50 diseases and 11 deaths.

Immediately after the outbreak, the Ministry of Agriculture and Rural Affairs sent a steering group to the local area. The local government has started the emergency response mechanism as required, and adopted measures such as blockade, culling, harmless treatment, disinfection, etc., to treat all the sick and culled pigs harmlessly. At the same time, all pigs and their products are prohibited from being transferred out of the blockade, and pigs are prohibited from being transported into the blockade. At present, the above measures have been implemented.

Poyang County, Jiangxi Province, Kunming Chenggong District, Xinjin County, Sichuan Province with each investigation and the outbreak of African swine fever
 
Date: 2018-11-17 15:30 Author: Source: Agriculture and Rural Department of Public Information Office 

　　Ministry of Agriculture and Rural Information Office November 17 release, Jiangxi Province, Poyang County in Shangrao City, Yunnan Province, Kunming Chenggong District, Chengdu, Sichuan Province Xinjin County investigation and the African swine fever epidemic.

　　At 12:17 on November days, the Ministry of agriculture and rural areas to the control center reported Chinese animal epidemic prevention, the China Animal Health and Epidemiology Center (National Center for Exotic Animal Disease Research) confirmed, Poyang County, a farm, a slaughter Chenggong District field, Xinjin County farm investigation and the African swine fever epidemic.

Among them, Poyang County farms 150 pig herds, the incidence of 10, died 10; Chenggong District slaughtered pig slaughterhouses a total of 348; Xinjin County 110 farm pig herds, the incidence of 27, died 13.

　　After the outbreak, the Ministry of Agriculture and Rural immediately sent a steering group to the local. Started as required by local emergency response mechanism, to take the blockade, culling measures to deal with harmless treatment, disinfection, culling of all pigs died and sound processing. At the same time, prohibiting all pigs and their products to bring up the blockade zone, prohibiting the transport of live pigs blockade zone. At present, these measures have been implemented.

South Korean CDC Announces Another Early Start To Their Flu Season

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Two years ago South Korea's CDC announced the start of their winter flu epidemic on December 8th, last year it was December 1st, and this year it has kicked off even earlier - November 16th. 

So far, Hong Kong and Japan report low levels of influenza activity, as have the United States and most of Europe. We should get new reports later today from our own CDC and from Public Health Canada.

While flu epidemic onset and severity can vary around the globe. this is a good reminder that now is the time to get the flu shot if you haven't already, as we often see a big uptick in flu activity in the United States between Thanksgiving and Christmas.

So far, what little activity we've seen has been primarily A/H1N1, a strain that the flu vaccine is generally pretty effective against. It takes a couple of weeks for immunity to kick in, however.

Some excerpts from today's Korean CDC announcement follow:

(translated)

Disease Control Division, Influenza Epidemic Notice
November 16, 2018 (Fri) Notice of influenza epidemic

◇ Recommendation for influenza vaccination and suspected symptom treatment
◇ Personal hygiene compliance orders such as hand washing, cough manners etc. to prevent infection and spread

The Ministry of Health, Welfare and Family Affairs (Jung Eun-kyoung) has issued the influenza epidemic on November 16, 2018, after 45 weeks (11.4 ~ 11.10) We called for compliance with personal hygiene regulations such as immunization, proper hand washing, and keeping cough manners.

* Influenza-like patient: a person with a sudden fever of more than 38 ° C with a cough or sore throat
** 2018-2019 season influenza strain criteria: 6.3 people / 1,000 people (6.7 people in the 2017-2018 season)
(Formula for influenza epidemics: ILI fraction + 2 × standard deviation for non-epidemic influenza over the past three years)

In addition, even if the epidemic has started to prevent and prevent the spread of influenza, the non-vaccine recipient will repeatedly be asked to receive the influenza vaccine,

* Influenza vaccination rate: 66.9% of children aged 6 months to 12 years old, 82.7%

       (Continue . . . )

China MOA: ASF Reaches Sichuan Province & Wild Boar In Jilin, New Outbreak Yunnan

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African Swine Fever continues to rack up territorial gains in China with Sichuan Province becoming the 18th administrative region to report an outbreak since August 1st.   

Additionally, Yunnan Province reports a new outbreak and Jilin Province - which reported their first outbreak in September - now reports finding the virus in a wild boar

Although wild boar (and ticks they carry) are known vectors for ASF, and have played a large role in the spread of the disease in Eastern Europe, this appears to be the first detection of this type in China.

Three reports from the MOA:

African swine fever epidemic in Gao County, Sichuan Province

Date: 2018-11-16 09:13 Author: Source: Ministry of Agriculture and Rural Press Office 

The Information Office of the Ministry of Agriculture and Rural Affairs announced on November 16 that an African swine fever epidemic occurred in Gao County, Yibin City, Sichuan Province.

At 21:00 on November 15, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Disease Prevention and Control Center and was diagnosed by the China Center for Animal Health and Epidemiology (National Center for Animal Disease Research).

 A farmer from Gaoxian County, Yibin City, Sichuan Province Pig plague. The farmer has 40 live pigs, 16 onset and 10 deaths.

Immediately after the outbreak, the Ministry of Agriculture and Rural Affairs sent a steering group to the local area. The local government has started the emergency response mechanism as required, and adopted measures such as blockade, culling, harmless treatment, disinfection, etc., to treat all the sick and culled pigs harmlessly. At the same time, all pigs and their products are prohibited from being transferred out of the blockade, and pigs are prohibited from being transported into the blockade. At present, the above measures have been implemented and the epidemic has been effectively disposed of.

And this:

Wild boar African swine fever epidemic occurred in Hanjiang District, Baishan City, Jilin Province

Date: 2018-11-16 18:38 Author: Source: Ministry of Agriculture and Rural Press Office 

The news office of the Ministry of Agriculture and Rural Affairs was released on November 16th, and the wild pig swine epidemic occurred in the Hanjiang District of Baishan City, Jilin Province.

At 11:00 on November 16, the Ministry of Agriculture and Rural Affairs received a report from the China Center for Animal Disease Control and Prevention, and was diagnosed by the China Center for Animal Health and Epidemiology (National Center for Animal Disease Research), and a wild boar test in the Hanjiang District of Baishan City, Jilin Province.

The result is positive for African swine fever virus nucleic acid.

After the outbreak, the Ministry of Agriculture and Rural Affairs and the State Forestry and Forestry Bureau immediately dispatched a supervision team to the local area to carry out epidemic situation supervision and epidemiological investigation. The local authorities have started the emergency response mechanism according to the requirements, and carried out harmless treatment and disinfection measures for sick and dead wild pigs, strengthened inspections of local wild boars, strictly restricted the stocking of nearby pigs, and inspected the surrounding wild boar activity areas to all surrounding pig farmers. Conduct investigations and comprehensive disinfection. At present, the above measures have been implemented.

 And finally this:

Weixin County, Yunnan Province, detected the African swine fever epidemic

Date: 2018-11-16 19:39 Author: Source: Ministry of Agriculture and Rural Press Office 

The Information Office of the Ministry of Agriculture and Rural Affairs was released on November 16th. Weixin County, Zhaotong City, Yunnan Province, detected the African swine fever epidemic.

At 14:00 on November 16, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Disease Prevention and Control Center and was diagnosed by the China Center for Animal Health and Epidemiology (National Center for Animal Diseases Research). A farmer in Weixin County, Zhaotong City, Yunnan Province. African swine fever. The farmer has 1 pig, 1 disease and 1 death.

Immediately after the outbreak, the Ministry of Agriculture and Rural Affairs sent a steering group to the local area. The local government has started the emergency response mechanism as required, and adopted measures such as blockade, culling, harmless treatment, disinfection, etc., to treat all the sick and culled pigs harmlessly. At the same time, all pigs and their products are prohibited from being transferred out of the blockade, and pigs are prohibited from being transported into the blockade. At present, the above measures have been implemented.

For years the fear had been that African Swine Fever would reach China - most likely seeping in from Russia (see FAO Risk Assessment African Swine Fever threatens People's Republic of China (excerpts below)). 

Possible pathways of ASF introduction into China are:

• transport-associated routes (TARs), including trucks, airplanes and ships carrying food contaminated with ASFV;
• legal or illegal introduction of infected animals (pigs or wild boar);
• contaminated foodstuffs and other legally imported goods;
• illegal imports of food products for private consumption or small-scale trade.

Furthermore, the Risk Assessment suggested:

• China’s northeastern region (Heilongjiang province) is where ASF is most likely to be introduced, followed by Inner Mongolia.
• Wild boar population density is the most relevant factor in the spread of the disease.
• The most likely regions for ASF spread are the northeast (Heilongjiang), followed by the central eastern area (Henan, Shanxi, Ammui, and Hubbei) and the southeast (Hunan). Surveillance for swine diseases in this region should be heightened.
• ASF is most likely to persist and become endemic due to the presence of wild boar populations interacting with susceptible domestic species, and lack of biosecurity in smallholdings.
• However, due to restrictions on hunting in China, hunters are not likely to affect the spread and persistence of the disease.

Unfortunately, the virus appears not to have read the above assessment, and instead of a cross-border incursion, followed by a slow and insidious spread across Northern and then East Central China - we've seen a blitzkrieg viral  assault that has spread across half of China in less than 4 months.

Imported contaminated food (or animal feed) remains the most likely source of infection, but that appears to have been aided and abetted primarily by human activities (legal & illegal transport of pigs, feeding swill, etc.)  - not wild boar - in these opening months. 

The almost inevitable detection of the virus in wild boar does mean that eradication becomes much more difficult, particularly if we start seeing additional reports from other provinces.

As we discussed yesterday in MOA Joint Statement On `Very Serious' Spread Of ASF, this unprecedented spread of African Swine Fever risks turning into a genuine national security issue for China, and the MOA and the Ministry of Public Security are adopting a hard line stance on enforcement of biosecurity rules and regulations.

Meanwhile, the bad news keeps on coming.

CDC: Record Number Of Tickborne Infections Reported In 2017

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With the caveat that many tickborne infections go unreported - and that the actual numbers are almost certainly much higher - according to the CDC 2017 set a record for the most reported tickborne infections in the United States.

There is a growing realization that the public health burden of tick and other vector borne diseases is likely much greater than previously appreciated.

• In 2013, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.
• A little over six years ago (see New Phlebovirus Discovered In Missouri) we learned about the new `Heartland Virus’ which made headlines when it was detected in two Missouri farmers with no epidemiological links and living 60 miles apart. Since then the number of cases – while small – has continued to grow (see MMWR: Heartland Virus Disease — United States, 2012–2013).
• SFTS or Severe Fever with Thrombocytopenia Syndrome - a tickborne Phlebovirus - was first discovered in China in 2009, but has been reported in Japan & Korea as well. It is genetically similar to the recently identified Heartland Virus (see MMWR: Heartland Virus Disease — United States, 2012–2013) and to a Novel Bunyavirus In Livestock – Minnesota first reported in 2013.

 The latest numbers on Tickborne diseases (for 2017) can be found at:

Tickborne Disease Surveillance Data Summary

Whether a new and emerging threat, or simply the result of our ability to finally recognize a long-time foe, we are becoming more cognizant of the dangers posed by ticks. With no vaccines to protect us, it makes sense to take additional precautions against ticks and other vector-borne diseases.

Yesterday the CDC published the following media statement on these latest numbers and ways to help protect again becoming infected.

Record Number of Tickborne Diseases Reported in U.S. in 2017

Media Statement

For Immediate Release: Wednesday, November 14, 2018
(404) 639-3286

New data from the Centers for Disease Control and Prevention (CDC) show tickborne diseases are again on the rise. In 2017, state and local health departments reported a record number of cases of tickborne disease to CDC.

Cases of Lyme disease, anaplasmosis/ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), babesiosis, tularemia, and Powassan virus disease all increased—from 48,610 cases in 2016 to 59,349 cases in 2017. These 2017 data capture only a fraction of the number of people with tickborne illnesses. Under-reporting of all tickborne diseases is common, so the number of people actually infected is much higher.

This increase follows an accelerating trend of tickborne diseases reported in the United States. Between 2004 and 2016, the number of reported cases of tickborne disease doubled, and researchers discovered seven new tickborne pathogens that infect people. The new data are from the Notifiable Disease Surveillance System (NNDSS). NNDSS tracks and monitors diseases of public health importance in the United States, including six reportable tickborne disease groups.

Reason for record number of tickborne diseases not clear

While the reason for this increase is unclear, a number of factors can affect tick numbers each year, including temperature, rainfall, humidity, and host populations such as mice and other animals. Tick densities in any year vary by region, state, and county. Numbers of reported tickborne disease cases are also affected by healthcare provider awareness, testing, and reporting practices. Finally, during any given year, people may or may not notice changes in tick populations depending on the amount of time they or their pets spend outdoors.

According to a recent CDC Vital Signs, the United States is not fully prepared to control these threats. Local and state health departments and vector control organizations face increasing demands to respond to ticks and tickborne diseases. Proven and publicly accepted methods are needed to better prevent tick bites and to control ticks and tickborne diseases.

Steps to protect against tickborne diseases

Until improved prevention and control methods are available, you can reduce your chances of being bitten by a tick by:

• Using Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone. Always follow product instructions.
• Treating clothing and gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings. Alternatively, you can buy permethrin-treated clothing and gear.
• Checking your body and clothing for ticks upon return from potentially tick-infested areas, including your own backyard. Use a hand-held or full-length mirror to view all parts of your body.

• Place tick-infested clothes in a dryer on high heat for at least 10 minutes to kill ticks on dry clothing after you come indoors. Showering soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tickborne diseases. Showering may help wash off unattached ticks and is a good time to do a tick check.

Resources

• 2017 Tickborne Disease Surveillance Data: https://www.cdc.gov/ticks/data-summary/index.html
• Notifiable Infectious Diseases and Conditions Annual Data Tables: https://wwwn.cdc.gov/nndss/infectious-tables.html#tabs-2-2
• Information about Lyme disease surveillance: https://www.cdc.gov/lyme/stats/survfaq.html
• Digital Press Kit, Lyme and other tickborne diseases: Prevention is key in fight against tickborne disease: https://www.cdc.gov/media/dpk/diseases-and-conditions/lyme-disease/index.html
• Vital Signs, Illnesses on the rise from mosquito, tick, and flea bites: https://www.cdc.gov/vitalsigns/vector-borne/index.html
• CDC Ticks website: https://www.cdc.gov/ticks/

More Outbreaks Of Hepatitis A & Upcoming CDC COCA Call

CDC Interactive Map

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Since March 2017 a number of states have been reporting community outbreaks of Hepatitis A - primarily among those who use injectable or non-injectable  drugs, the homeless, and their close direct contacts.

Five months ago, in CDC HAN Advisory On Outbreak of Hepatitis A Virus (HAV) Infections among Drug Users & The Homeless, the CDC reported:

From January 2017 to April 2018, CDC has received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states. Of the more than 1,900 reports for which risk factors are known, more than 1,300 (68%) of the infected persons report drug use (injection and non-injection), homelessness, or both.8-11

Since then, reports of community-wide outbreaks have continued, and on November 29th the CDC will hold a COCA Call for healthcare providers (Hepatitis A Outbreaks in Multiple States: CDC Recommendations and Guidance).

Overview

Hepatitis A is a highly contagious, vaccine-preventable, viral disease spread via a fecal-oral route or by exposure to contaminated food or water. Hepatitis A rates have declined substantially in the United States since the introduction of the hepatitis A vaccine in 1996.

However, since early 2017, the Centers for Disease Control and Prevention (CDC) has observed an increase in the number of community-wide hepatitis A outbreaks in multiple states. For these outbreaks, CDC recommends vaccination for persons who report drug use (injection and non-injection), persons at high risk for drug use (e.g., participating in drug substitution programs, receiving substance abuse counseling or treatment, recently or currently incarcerated), men who have sex with men, and persons experiencing homelessness.

CDC also encourages vaccination in certain settings such as emergency departments and corrections facilities in outbreak-affected areas when feasible. During this COCA call, subject matter experts from CDC will discuss vaccination to stop these outbreaks and current CDC recommendations for the hepatitis A vaccine.

While Hepatitis A infection in a healthy adult usually results in a mild illness of a few week's duration - for some - particularly for those with compromised immune systems, it can be far more serious.

The CDC describes the way the virus spreads as:

Transmission / Exposure

How is hepatitis A spread?
Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.

Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.

While relatively rare, food handlers who are infected with the virus can sometimes pass on the infection to their customers. This past week Mecklenburg County Public Health (North Carolina) issued the following alert after an employee from a local restaurant tested positive.

Possible Public Hepatitis A Exposure at Village Tavern on Congress Street; Vaccination Clinics Scheduled 

11/8/2018

​Patrons who ate at Village Tavern in Charlotte on Oct. 30 should receive a hepatitis A vaccination as soon as possible.

Public Health Director Gibbie Harris announced today that the outbreak identified by the State and Centers for Disease Control earlier this year in Mecklenburg County has led 24 cases since Jan. 1, including a Village Tavern employee diagnosed Wednesday.

“After consulting with the State today, we are recommending a vaccination for all employees and exposed patrons who ate at Village Tavern located at 4201 Congress Street on Tuesday, Oct. 30,” Harris said. “According to the Centers for Disease Control (CDC), the vaccine must be given within 14 days of exposure for it to be effective.”

Public Health vaccination clinics for customers who might have been exposed and for residents who meet the high-risk factors for hepatitis A will be held at Mecklenburg County Health Department, 249 Billingsley Road:

Thursday, Nov. 8, 8 a.m. – 5 p.m.
Friday, Nov. 9, 8 a.m. – 5 p.m.
Saturday, Nov. 10, 9 a.m. – Noon
Sunday, Nov. 11, 9 a.m. – Noon
Monday, Nov. 12, 9 a.m. – Noon
Tuesday, Nov. 13, 8 a.m. – 5 p.m.

People who dined at Village Tavern on Oct. 30 are strongly urged to get a vaccination in the next six days.

Public Health announced on June 6 that North Carolina Public Health officials and the CDC declared an outbreak of the liver disease in Mecklenburg County. Those who have had a hepatitis A infection, or one hepatitis A vaccination, are protected from the virus and do not need to take action.

The high-risk factors include:

• Those who are household members, caregivers, or have sexual contact with someone who is infected with hepatitis A
• Men who have sexual encounters with other men
• Those who use recreational drugs, whether injected or not
• Recent travel from countries where hepatitis A is common
• Homeless individuals who do not have easy access to handwashing facilities

The best ways to prevent hepatitis A include:

• Get the hepatitis A vaccine,
• Practice safe handwashing procedures – wash your hands under warm, soapy water for at least 20 seconds after using the bathroom or changing diapers and before you prepare food, and
• Wear a condom during sexual activity.

Yesterday the Tennessee Department of Health issued a statement on the recent (rare) death due to Hepatitis A, and warned that additional deaths were possible.

TDH Continues Response to Hepatitis A Outbreak
Wednesday, November 14, 2018 | 10:11am

NASHVILLE – The Tennessee Department of Health continues to investigate and respond to a hepatitis A outbreak impacting the state with more than 400 cases of illness to date. One death associated with this hepatitis A outbreak has been reported. The outbreak in Tennessee most heavily affects Nashville and Chattanooga.

“We are very saddened by the recent death associated with hepatitis A and realize unfortunately, we could see more deaths, as this continues to be a very serious outbreak with more than half of the people identified with the illness needing hospitalization,” said TDH Commissioner John Dreyzehner, MD, MPH. “We will continue to respond aggressively, vaccinating high risk populations, educating and working with partners in and out of Tennessee to seek additional ways to stem this outbreak.”

Tennessee’s hepatitis A outbreak is linked to a large, multi-state outbreak that began in 2017. This outbreak is primarily affecting recreational drug users and people experiencing homelessness.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus. It is usually transmitted from one person to another through contact with contaminated feces or consumption of contaminated food or water. The most at-risk groups for hepatitis A include recreational drug users, men who have sex with men and people experiencing homelessness. Many of the hepatitis A cases in the current outbreak are associated with recreational drug use.

“More than 36,000 doses of hepatitis A vaccine have been provided to those most at risk in our state and I believe this massive effort has made a huge difference in reducing the number of hepatitis A cases,” said TDH Assistant Commissioner for Communicable and Environmental Diseases and Emergency Preparedness Tim Jones, MD.

“We urge anyone in the high risk groups to get vaccinated as soon as possible, and will continue to work with state and local partners to provide hepatitis A vaccine to people at high risk for infection and educate people on how to prevent the spread of this disease.”

(Continue . . .)

For more on Hepatitis A, the CDC has a webpage:

Hepatitis A Questions and Answers for the Public