Hepatitis A is on the rise in Florida, and Tampa Bay has the highest number of reported cases in the state. Here's what you need to know about the infection and how it might affect you.
Why we should pay attention: eye-popping numbers
Two local restaurants were shuttered last year — one temporarily and the other permanently — due to reported hepatitis A cases among food workers, and even more eateries have been the subject of investigations this year. A case of hepatitis A also was reported in the Pinellas County Jail earlier this month.
These cases are among a growing number of infections nationally, the largest outbreak since the hepatitis A vaccine was developed nearly 20 years ago, health officials say.
There have been 1,037 cases of hepatitis A so far this year in Florida, according to the state health department, compared to 548 last year. The numbers have been more or less doubling every year: In 2017, there were just 276 cases statewide, and in 2016, just 122.
In Pinellas County, which has the highest number of cases in the state, there have been 157 cases so far in 2019, which is already more than 118 cases reported for all of 2018 in the county. In 2017, there were zero cases. And in 2016, there were two.
Hillsborough County has reported 58 cases so far this year, compared to the 23 on average from 2016 to 2018.
Generally, fewer than 3,000 cases of hepatitis A are reported nationwide each year, according to the Centers For Disease Control and Prevention. But that hasn't been the case recently. More than 7,000 cases were reported from 12 states in 2018.
The Florida Department of Health issued an advisory expressing concern about the rise in cases in November. But while outbreaks in local restaurants grabbed the headlines, less than 5 percent of new hepatitis A cases have come from food service worker-related cases, said the health department's lead epidemiologist, Dr. Carina Blackmore.
"This is really an outbreak that's spread directly from person-to-person contact. If you handle a cigarette that someone with hepatitis A has been smoking, or eating utensils they have used, you may be at risk," said Blackmore. "But it's really unfortunate that there's been such a focus on restaurants, because only a few of our cases have been food workers at this point. And we don't have any evidence of hepatitis A being transmitted from any restaurant."
How it spreads. What it feels like. Your risk of getting it.
Hepatitis A is spread person-to-person through feces contaminated with the virus. It can be spread by mouth, from eating or drinking contaminated food or water, or through sex. Symptoms include fever, dark urine, yellow-tinged skin or eyes, fatigue and gastric issues. It can also cause damage to the liver, especially among those who already have liver disease.
"Hepatitis A is more contagious when a patient is having explicit symptoms, like diarrhea. But not everyone who has hepatitis A becomes really ill," Blackmore said.
Public health experts say the majority of the cases come from white men in their young adult years to middle age. Most are from transient populations with limited access to sanitation methods and are more commonly drug users.
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But not everyone needs a vaccine if they want to go out to eat at restaurants, said Kevin Watler, a spokesman with the Hillsborough County health department.
"Unless you are homeless, a drug user or have recently spent time in jail, you're not at a great risk," he said. Cooked food poses little threat to patrons, because even if the food was contaminated, cooking it often kills off the virus.
Once someone has had hepatitis A, they cannot get the virus again.
How the health department investigates hepatitis A and alerts the public
County health departments follow state protocols and guidelines set by the CDC to investigate all reported cases of hepatitis A and a number of other contagious diseases that are considered a public health threat. However, health departments do not issue public alerts for every investigation they conduct, officials say.
Only investigations that rise to the level of a public health threat are reported widely to the community, Blackmore said.
Investigations are confidential while they're taking place. During this time, health officials will identify and interview a patient who tested positive for hepatitis A. They will interview coworkers and managers, close friends and relatives, Blackmore said.
They also will put together a timeline to determine if the patient was working while he or she was sick. If the person worked in a restaurant, investigators will determine if he or she handled food and what hygiene practices are in place at the establishment (if they wore gloves and how often they wash their hands, for example).
It's also crucial to determine when a person contracted hepatitis A in order to know how infectious they may be to others, Blackmore said.
"It's rare that someone is working while they are contagious," said Maggie Hall, a spokeswoman with the Pinellas County health department. "The CDC also outlines that food handlers are not at an increased risk for hepatitis A. They very rarely, if ever, transmit the virus to patrons. We haven't seen a case where somebody has gotten hepatitis A from eating at a restaurant where someone was contagious."
The health department investigated two cases that rose to the public threat level in the last year in Pinellas County. One was at the Toasted Monkey bar and grill on St. Pete Beach and another was at an Arby's in north Clearwater. In both cases, coworkers and patrons were advised to get vaccinated.
"We make a judgment based on all the facts we gathered to determine if patrons may possibly be at risk," Blackmore said. "It can be misleading to put out an alert about every investigation when there is no risk to the public."
Hepatitis A, while contagious and can infect anyone, is not considered to be as imminently contagious as a disease like the measles, which is spread in the air through coughing and sneezing. If hepatitis A is diagnosed within two weeks, vaccination is recommended. After that, the threat is deemed less of a risk.
Why hepatitis A has been a contentious issue in Tampa Bay
In November, the Division of Hotels and Restaurants at the Florida Department of Business and Professional Regulation investigated a case of hepatitis A in a food worker at Hamburger Mary's in Ybor City. The agency closed the restaurant temporarily during the inspection, but its owners chose to shutter it permanently, saying news of the case had become too challenging to overcome.
Former employees, including the restaurant's infamous drag queen performers, told the Hillsborough County Commission months later how the health department mishandled the investigation, which led to several former employees scrambling to find work. The health department did not find any instances where Hamburger Mary patrons had become sick or contracted hepatitis A from the restaurant during their investigation.
Emotions ran high during the commission meeting as critics accused Hillsborough health department director Dr. Douglas Holt of making discriminatory comments in television news interviews after the restaurant's closure. Holt said his comments were taken out of context.
But hepatitis A cases have continued to rise since then. Other restaurants in the area faced health department investigations, but they did not rise to the level of a public threat, officials say.
One of those restaurants is Ulele, on Tampa's riverfront, owned by Richard Gonzmart. On Feb. 6, the health department was notified by a local hospital of a Ulele worker with hepatitis A, said Michael Kilgore, chief marketing officer with the Columbia Restaurant Group.
The entire Ulele staff was notified and complied with an unannounced inspection from health department officials. All of Ulele's 60 employees were vaccinated, Kilgore said, and the restaurant was given "a clean bill of health by both local and state health department officials."
"Ulele staff members are required to always wear disposable gloves while handling food and wash hands frequently, including after bathroom visits," Kilgore said.
The health department determined there was no risk to patrons due to the hepatitis A activity.
How to protect yourself
The Florida Department of Health is reaching out with vaccinations to communities that are most at risk for the illness: people who report drug use, homeless populations and gay men. In addition, the department will be working with local jails, drug treatment centers, homeless shelters and hospitals to educate and vaccinate.
Vaccinations are being offered for free or at reduced rates in health department clinics across the Tampa Bay area.
Florida health officials say hepatitis A is vaccine-preventable illness. It's not a required vaccine for school immunizations, but it is recommended for children at 1 year old. The vaccine is also recommended for people who travel internationally.
Practicing proper hygiene, like washing hands thoroughly before preparing or eating food, is another way to protect against the virus.
Anyone interested in receiving the vaccine should talk to their physician about it, Blackmore said.
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.