Lexington-Fayette County Health Department
- An outbreak of hepatitis A virus has been identified in Kentucky, mostly concentrated in the Jefferson County and Louisville metro area.
- Among the risk factors are homelessness and any form of illicit drug use
- If hepatitis A infection is suspected based on clinical assessment:
o obtain a specimen for initial IgM anti-HAV testing,
o collect an additional vial of blood to submit for confirmatory RNA testing if initial testing is positive,
o alert the local health department in the patient’s county of residence, and
o consider administering the attached 1-page questionnaire to gather patient risk factors.
Hepatitis A is a contagious viral illness characterized by fever, malaise, jaundice, anorexia, and nausea. The incubation period ranges from 15-50 days.
An outbreak due to hepatitis A virus (HAV) has been identified in Kentucky. At least seven Kentucky cases are genetically linked to a large HAV outbreak in California. Acute hepatitis A cases have been confirmed in several counties in Kentucky, with the majority of cases in the Jefferson County/Louisville area. Several of the cases have been homeless and/or used illicit drugs. Forty three cases have been reported as part of this outbreak starting August 1, 2017 (10-year average: 20 cases/year). Cases due to the same HAV strain have been identified in both Arizona and Utah. Transmission is presumed to occur person-to-person; no commercial food product has been identified as being contaminated. Based on current information, populations who are homeless or use illicit drugs are considered at risk, if exposed to HAV.
If acute hepatitis A is suspected based on clinical assessment, please obtain a specimen for IgM anti-HAV testing, as well as liver function tests to include AST, ALT, and bilirubin. In order to confirm hepatitis A cases with this outbreak, additional molecular testing for HAV is recommended. Please draw an additional tube of blood to be held by the lab and sent to the Kentucky Division for Laboratory Services, should the IgM antibody for HAV test be positive. Contact the Lexington-Fayette County Health Department for additional laboratory guidance.
Offer hepatitis A vaccine to persons who have not been previously vaccinated, especially those who are homeless or report using injection or non-injection illicit drugs. Public health authorities will assist in determining if post-exposure prophylaxis is warranted for contacts of an acute case.
A number of cases in this outbreak are people who are difficult to contact for further testing or investigation. To assist in the investigation, please consider completing the attached questionnaire as soon as possible when hepatitis A is suspected for any patient. Send the completed questionnaire to the local health department in the patient’s county of residence. Questionnaire Link: Suspect HAV Factor Questionnaire
Report suspected cases of acute hepatitis A to the local health department in the patient’s county of residence within 24 hours. Reports for Fayette County residents should be called to 859-231-9791.
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FOR MORE INFORMATION:
Please call the Lexington-Fayette County Health Department at 859-231-9791, or visit the Centers for Disease Control and Prevention (CDC)’s website for additional information: