State and local officials in New Jersey have been working to tamp down an outbreak of hepatitis A that has resulted in over 300 new cases — and three deaths — in the last seven months, part of a rapid uptick in the infection reported in more than two dozen states nationwide.
While other forms of hepatitis — a highly contagious liver infection — are more common, the state Department of Health had confirmed 326 cases of the hep A virus (HAV) between Dec. 1, 2018 and July 27, some seven times the number diagnosed over the same period the previous year. Most of these cases are considered part of the same outbreak, which required 210 people to be hospitalized.
According to New Jersey data, roughly one-third of the new cases were in Camden County; Gloucester County, to its south, and Burlington, to the north, reported the second and third highest case numbers, respectively. Philadelphia is also experiencing an outbreak, with 91 cases reported to the city’s Department of Public Health so far this year.
Individuals who use intravenous drugs or are homeless are particularly at risk, health officials note, and they have focused on these populations when distributing hep A vaccines, which can prevent the infection and reduce the impact of symptoms for those that do contract the virus. HAV does not cause long-term liver damage but can result in a range of serious symptoms for which there is no single, specific treatment.
Garden State officials are encouraging vulnerable residents to get tested and vaccinated, a protection that can last at least a decade. The DOH has supplied county health departments with hundreds of free vaccines they can provide to uninsured residents or others most at risk. And county and local health departments have partnered with community clinics, shelters and homeless programs to encourage people to take advantage of these services, the state said.
Risks and protections
“Individuals should talk with their healthcare provider about their risk and steps they can take to protect themselves,” acting DOH Commissioner Marcela Ospina Maziarz said in a statement Friday.
The DOH referred people to a risk-assessment tool developed by the federal Centers for Disease Control and Prevention to help them better understand hepatitis and what to do if they may be infected.
The epidemic’s scope in New Jersey’s pales in comparison with the impact it has had on some other states, according to CDC reports. Officials in Kentucky have diagnosed nearly 4,800 people since the outbreak began there roughly two years ago, including 59 who have died. Ohio has recorded more than 3,200 cases, of which 14 were fatal.
Nationwide, 25 states have reported HAV outbreaks since 2016, resulting in nearly 22,600 cases, more than 13,000 hospitalizations and 221 deaths, the CDC notes. (Despite the cases in Philadelphia, Pennsylvania has not reported enough cases to be considered an outbreak state; neither has New York.)
The more common forms of hepatitis, B and C, are transmitted by blood — and, for hep B, other bodily fluids. The virus can be passed through shared drug needles and unprotected sex and from mother to child during birth. Both these forms can be acute (short-term) or develop into (long-term) chronic illness that can lead to liver cancer or organ failure, according to the DOH.
Hep B and hep C
In 2018, New Jersey recorded 64 acute and 407 newly diagnosed chronic hep B cases, as well as 112 acute and 7,148 new chronic hep C cases, the state said. Hep C rates have increased steadily in recent years, in part related to rising IV drug use connected to the opioid epidemic, and an estimated 169,000 New Jerseyans now live with this form of disease.
Hep A, the rarest form, is transmitted primarily through contact with contaminated feces; epidemiologists say it takes only a trace of the virus to lead to infection. It can spread quickly among people who are living in unsanitary conditions or engaging in risky behaviors, like needle-sharing. In all of 2018, some 70 cases were diagnosed in New Jersey.
“The Department continues to encourage vaccination for Hepatitis A and B, especially for those who are most at risk,” the DOH’s Maziarz said. (There is currently no vaccine approved for hep C, but new pharmaceutical treatments are considered highly effective.)
“Those with hepatitis C may have no symptoms and live with the disease for decades without feeling sick, all while liver damage may be taking place without their knowledge,” she added. “This is why getting tested is a critical step.”
When it comes to hep A, some people infected have no symptoms at all — fueling the possibility of further transmission — while others may take two weeks to nearly two months before they develop any outward signs of the disease.
Symptoms, if they do show, can last for weeks or months and include yellowing skin and eyes, dark urine and stool, exhaustion and joint pain, fever, nausea, vomiting and diarrhea, according to information shared by the DOH. Death may be rare, but it is possible.
To avoid spreading the disease, the state is urging people to practice good hand-washing and other hygiene — especially after using the bathroom — as well as to get tested and vaccinated. Even two weeks after exposure, proper inoculation can protect against symptoms, experts note, and can help prevent HAV illness in the future.
A list of testing sites in each county and other resources — including the location of New Jersey’s existing needle-exchange programs — can be found in the DOH’s Viral Hepatitis Resource Guide, published last spring. Needle-exchange programs, which enable drug users to access clean syringes, are considered an important component in reducing the spread of hep C and other infectious diseases.