Advertisement
  1. Health

Why are we suddenly hearing about hepatitis A outbreaks? Experts blame the opioid crisis.

Hillsborough and Pinellas counties have seen a significant spike in hepatitis A cases this year, part of a national trend. Experts blame the opiod crisis, which has led to infections resulting from widespread IV drug use and homelessness. [Getty Images]
Published Nov. 9, 2018

In just the last two weeks, one restaurant in Tampa Bay has shut down and another closed temporarily after outbreaks of hepatitis A. Health officials in Hillsborough and Pinellas counties say reports of the virus are way up, and they worry that more are likely to come.

The cases are among a growing number of infections nationally, the largest outbreak since the hepatitis A vaccine was developed nearly 20 years ago.

So why is this happening now?

"The spread is intimately linked to the opioid crisis," said Jill Roberts, a professor of microbiology and environmental health at the University of South Florida. "The biggest factors to this spread are IV drug use and homelessness. And now we're seeing this spill over into restaurants."

The owners of a Hamburger Mary's franchise in Ybor City announced this week that the restaurant would not reopen after being closed temporarily when a worker there tested positive for hepatitis A. An announcement on its Facebook page lamented, "The latest challenge over the last couple of weeks has proven too much to overcome."

In response, the Hillsborough health department received 400 calls and administered 620 free hepatitis A vaccines to restaurant patrons.

RELATED: Hamburger Mary's in Ybor City to close in wake of worker testing positive for hepatitis A

And on Monday, the Toasted Monkey Beach Bar & Grille on St. Pete Beach temporarily closed when one of its workers also tested positive for the virus.

"We alerted the public because of the number of patrons who could have been exposed to the virus while the person was on duty at the restaurant," said Maggie Hall, a spokeswoman with the Pinellas health department.

Hepatitis A is spread person-to-person through feces contaminated with the virus, so practicing proper hygiene is essential, health officials say. Symptoms include fever, dark urine, yellow-tinged skin or eyes, fatigue and gastric issues. It can cause damage to the liver, especially among those who already have liver disease.

At least 58 cases of the virus have been reported in Pinellas this year, including a jump of 10 cases from September to October. Last year, the county reported zero cases. In 2016, there were just two, and in 2015, just four.

Hillsborough County, meanwhile, has reported at least 36 cases of hepatitis A so far this year, compared to 10 all of last year and five in 2015 and 2016.

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 outbreak-associated cases have been reported from 12 states this year, said Dr. Monique Foster, an epidemiologist at the CDC.

"In the previous decade, most large outbreaks of hepatitis A were attributed to contaminated commercial food products. During 2017, however, most reports were primarily among people reporting drug use or experiencing homelessness," she said. "Our most recent national data shows states experiencing outbreaks are facing unique challenges to reach people who are at greatest risk for infection."

California Gov. Jerry Brown declared a state of emergency last year over an outbreak of hepatitis A cases that began in San Diego and spread to the Los Angeles, Monterey and Santa Cruz areas. The state has been battling a rise for years, but in 2017 it reported more than 700 active cases with more than half of those patients needing to be hospitalized. All told, 21 people have died.

Getting the outbreak under control was a costly endeavor — California bleached the streets in San Diego, set up mobile vaccination units and hosted hundreds of vaccination events, opening dozens of public hand-washing stations.

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.

"We're a little late to the game, in that we should have remembered the lessons we learned from other diseases, like the spread of HIV," said Roberts, the USF professor. "The major factor is using dirty needles in unclean conditions. Restaurants are particularly susceptible to this population because they offer generally low-paying jobs, and there is a lot of turnover in employees. If someone who has active hepatitis A is handling food in a restaurant, all of those customers are at risk."

There is no requirement for food handlers to be vaccinated against hepatitis A, said Dr. Kartik Cherabuddi, a physician with UF Health that specializes in infectious diseases.

"We predominantly don't see many outbreaks in restaurants because generally, food handlers are trained well in this country," he said.

But health inspections by the Florida Department of Business and Professional Regulation show that the two local restaurants with positive cases had a recent history of sanitation issues. Reports from earlier this year show that food service workers at both Hambuger Mary's and the Toasted Monkey lacked knowledge of food-borne illnesses and employees were handling food without washing their hands or wearing gloves.

The Florida Restaurant and Lodging Association is keeping an eye on the situation and alerting its members to do the same, said spokeswoman Amanda Handley.

"The food code has very clear, effective policies regarding employee illness, and all who work in food service are required to have training to help keep everyone safe and healthy," she said. "We have scheduled some social media posts to go out reminding members to ensure all employees are trained and directing them to our SafeStaff Food Handler training. Additionally, we have drafted messaging to include in our monthly newsletter."

Consumers should also be aware of the outbreaks in their communities, as some may be at higher risk to contracting the virus than others, such as people who previously have been in jail or traveled internationally. All 1-year-old children, transient people, users of recreational drugs and gay men are encouraged to be vaccinated as soon as possible.

ALSO READ: In Pinellas, three cases of the measles revive concerns about those who don't vaccinate

"The older you are, the higher the risk," Roberts said. "In Florida, the vaccine has been on the schedule for 20 years. If you are older than that, there's a good chance you never got vaccinated."

People who catch hepatitis A are the most infectious during the two weeks before they experience symptoms, Foster said.

"Many who are infected do not have symptoms that require medical care, some may unknowingly infect others before they know that they are infected," she said. "This makes it difficult to find cases and provide timely vaccine to prevent people who were exposed to the virus from becoming infected."

In addition to the vaccine, washing hands after a bathroom visit and after changing diapers lessens the chance that contamination will spread. But vaccination is the best protection against the virus.

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.

____________

ALSO IN THIS SECTION

  1. Fifty-two percent of Americans support a ban on the sale of electronic cigarettes with fruit and other flavors, according to new Kaiser Family Foundation poll. TONY DEJAK  |  AP
    But a smaller percentage supports banning all forms of the product. Most younger adults oppose both ideas.
  2. FILE - In this Thursday, Dec. 20, 2018 file photo, Juul products are displayed at a smoke shop in New York. On Thursday, Oct. 17, 2019, the company announced it will voluntarily stop selling its fruit and dessert-flavored vaping pods. SETH WENIG  |  AP
    The flavored pods affected by the announcement are mango, crème, fruit, and cucumber.
  3. Travis Malloy who runs an 8-acre farm with his assistant Shelby Alinsky on the east side of Temple Terrace, raises organic beef, pigs, turkeys and chickens. Malloy has also set up a number of...
  4. Dr. James Quintessenza, left, will return as the head of the Johns Hopkins All Children's heart surgery program department. UNIVERSITY OF KENTUCKY HOSPITAL  |  Times
    The heart surgery program’s mortality rate spiked after the surgeon left, a 2018 Times investigation revealed.
  5. Stephanie Vold, a medical assistant and intake specialist for OnMed, holds the door while Austin White, president and CEO of the company, talks with a nurse practitioner during a demonstration of their new telehealth system at Tampa General Hospital on Tuesday. The hospital is the first to deploy the OnMed station and plans to install them at other locations. OCTAVIO JONES  |  Times
    The closet-size “office” with a life-size screen is another example of the changing face of medicine.
  6. Marijuana plants grow in a greenhouse environment in this room at the Curaleaf Homestead Cultivation Facility. This environment controls the amount of natural sunlight and artificial light the plants are exposed to, as well as the temperature. EMILY MICHOT  |  Miami Herald
    An Atlanta broker is listing one license for $40 million and the other for $55 million.
  7. A page from the Medicare Handbook focuses on Medicare Advantage plans, which have become increasingly popular in recent years. Medicare's open enrollment period for 2020 begins Oct. 15 and lasts through Dec. 7. PABLO MARTINEZ MONSIVAIS  |  AP
    New benefits are giving an extra boost to Medicare Advantage, the already popular alternative to traditional Medicare.
  8. The Tampa Bay Times' annual Medicare Guide explains how the program is set up, helps you compare options available in the Tampa Bay area, and points the way toward help, including free, one-on-one assistance. This illustration will grace the cover of LifeTimes on Oct. 23, when the guide will be published in print. RON BORRESEN  |  Tampa Bay Times
    As the open enrollment period begins, it’s time to review your coverage.
  9. The Medicare Handbook for 2020 is a good resource to have as the annual open enrollment period gets under way. The government usually mails beneficiaries a copy. Find a PDF version to print at medicare.gov/pub/medicare-you-handbook, or call 1-800-633-4227 (1-800-MEDICARE) to order a copy. THOMAS TOBIN  |  Tampa Bay Times
    The open enrollment period, which lasts into December, is a time for millions of beneficiaries to review, and possibly change, their coverage.
  10. Medicare's online Plan Finder has been redesigned and is available at medicare.gov/find-a-plan. THOMAS TOBIN  |  Tampa Bay Times
    The most-used tool on Medicare.gov will look different this year.
Advertisement
Advertisement
Advertisement