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Florida faces hepatitis A emergency - and there’s no end in sight

Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018.
The Florida Department of Health in Hillsborough County identified a positive case of hepatitis A in a food service worker at Hamburger Mary's in Ybor City on Oct. 22, 2018. [JOSH FIALLO | Times] [JOSH FIALLO | TIMES | JOSH FIALLO | Times]
Published Sep. 17
Updated Sep. 17

TALLAHASSEE — Florida’s ongoing hepatitis A epidemic has already far eclipsed state records, but people shouldn’t expect the outbreak to end anytime soon, the state’s surgeon general told lawmakers Tuesday.

Scott Rivkees, the newly installed head of the state’s Department of Health, said that 3,009 cases of the virus have been reported this year as of September 7, and that the state is still working to vaccinate hundreds of thousands of high-risk or medically vulnerable patients to curb the virus’ spread.

Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018 — but it is unclear what fraction of those vaccinated are part of the high-risk population that federal officials recommend should be 80% vaccinated to curtail an outbreak. At least 83,733 people deemed at “high risk” have been vaccinated by county health departments since the beginning of 2018, according to the state Department of Health.

RELATED STORY: We went to a class on hepatitis A. Here’s what we learned.

There are about 491,000 people deemed high-risk in Florida, referring to people who use recreational drugs or are homeless. An additional 838,500 people are considered medically vulnerable — with an underlying liver disease or who are over 60 with a chronic medical condition.

“It’s going to take us a while” before the outbreak ends, Rivkees told the Senate Health Policy committee. He added Floridians should remain vigilant about getting vaccinated and practicing good hygiene.

Hepatitis A, a highly contagious virus that can cause liver damage, is passed from person to person in several ways, from eating or drinking food or water contaminated with fecal matter with the virus or through sex. Symptoms include fever, fatigue, gastric issues, nausea, darker urine and jaundice.

Cases for the prior five years have hovered in the hundreds, but this year shot above 3,000 by early September, fueled in part by a national rise of cases that have traveled across state lines from the Appalachian region, Rivkees said. Public health experts have linked the outbreak to the opioid crisis in that region, he added.

More than 25,000 cases have been reported across the country. In Florida alone, more than 2,300 people have been hospitalized this year with the virus and 40 have died. Florida’s cases are concentrated in a central band of the state, though nearly every county in the state has had at least one case this year.

RELATED STORY: Hepatitis A explained: What you should — and shouldn’t — worry about while dining out

The state declared a public health emergency on August 1 for all counties, with a focus on 17 “critical” counties stretching from Pinellas and Pasco counties to Brevard and Volusia counties. The state has received reports of several cases of hepatitis A in food service workers, but Rivkees said so far the state does not know of any cases of transmission to diners.

Rivkees said the state is working with county health departments to provide free and low-cost vaccines to people who are uninsured or under-insured. He added those county departments are working with local organizations like homeless coalitions and jails, where he said people are more likely to have used drugs, to vaccinate people who might be at higher risk.

Federal officials have also provided more resources and vaccine doses to help Florida curb the epidemic, he said.

Committee chair Sen. Gayle Harrell, R-Stuart, said that Rivkees also sought to have vaccines available at hurricane shelters opened for Hurricane Dorian earlier this month to reach more people, an approach she praised.

According to the state Department of Health, the federal Centers for Disease Control and Prevention have advised that about 80% of people deemed high-risk — about 392,000 people in Florida — need to receive the vaccine to significantly slow an outbreak’s spread.

County health departments have vaccinated at least 20 percent of that “high risk” population since 2018, though the state Department of Health does not have numbers for how many additional people who meet that criteria have been vaccinated by other providers.

Rivkees did not answer questions Tuesday when he left the meeting.

Rivkees, who officially started his job this summer, has yet to be confirmed by the Senate. When sexual harassment accusations arose shortly after his nomination this spring, Senate President Bill Galvano, R-Bradenton, said the chamber would delay confirmation hearings for Rivkees until the 2020 session. Rivkees, in an unusual arrangement, is also maintaining his tenured post as a University of Florida professor while taking on his job as surgeon general.

That prompted Sen. Darryl Rouson, D-St. Petersburg, to question Rivkees’ “attention paid to the public health emergency” while he splits his time between Gainesville and Tallahassee.

But before Rivkees could answer, that question was quickly shot down by Harrell, who said such questions should be saved for a future confirmation hearing.

“The question screams in my mind,” Rouson responded. “I would be remiss not to address it.”

What is Hepatitis A?

Hepatitis A is a highly contagious virus that can cause serious liver damage.

How is Hepatitis A spread?

Hepatitis A is spread through fecal matter contaminated with the virus. It can be passed person-to-person by mouth (such as through eating or drinking food or water with the virus) or through sex or shared drug use. It can also be passed by sharing hygiene tools like toothbrushes or razors — the latter can cause tiny abrasions opening up the skin to the virus. Someone with hepatitis A can be contagious two weeks before symptoms start showing.

How did this outbreak start?

The outbreak likely started in the upper Appalachian region early last year, Florida Surgeon General Scott Rivkees said, and public health experts have linked the current rash of cases to the opioid crisis — tied to risk factors like IV drug use and homelessness — in that region. It has since spread south and west across several states.

Who is in danger of contracting hepatitis A? Who is high-risk or medically vulnerable?

The state has deemed about 491,000 people “high-risk,” referring to people who use recreational drugs or are homeless. It is also looking at people who are “medically vulnerable” — people with an underlying liver disease or who are over 60 with a chronic medical condition.

Federal officials recommend several categories of people get a vaccine, including people traveling to countries where hepatitis A is common or interacting regularly with people who have hepatitis A, men who have sexual encounters with other men, users of recreational drugs, people who are homeless or have unstable housing, people with chronic or long-term liver disease, or people with clotting-factor disorders.

Rivkees said the epidemic has involved adults, in part because children have been regularly vaccinated for hepatitis A since 2005.

How can I avoid getting hepatitis A?

The best way to avoid getting hepatitis A is to get a vaccine. It is usually given as two doses, six months apart. Practicing good hygiene — washing your hands and avoiding dirty surfaces — is also important. Hepatitis A can survive for days or weeks on surfaces like bathroom countertops. Public health experts have recommended sanitizing surfaces with bleach — the virus is not usually killed off by alcohol-based sanitizers.

At restaurants, hepatitis A can be killed off by heat, so people should also avoid eating anything uncooked such as seafoods or salads.

Where do I find a vaccine?

Talk to your healthcare provider or pharmacist about the vaccine and where to get it. You can also call county health departments, which Rivkees said are providing hepatitis A vaccines across the state. People who are high-risk, uninsured or underinsured people can get the vaccine for free. You can also use the site VaccineFinder.org to find vaccine in your area.

If you’re not sure if you’ve been vaccinated, doctors can test to see if you’ve already received the vaccine.


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