Kentucky’s Hepatitis A outbreak: A wake-up call and a symptom of our public health crisis

ABCs of hepatitis: What’s the difference between A, B, C?

Hepatitis is a disease characterized by inflammation of the liver. It comes in many forms, including hepatitis A, B and C. But what do those letter designations mean, and how do they differ from one another?
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Hepatitis is a disease characterized by inflammation of the liver. It comes in many forms, including hepatitis A, B and C. But what do those letter designations mean, and how do they differ from one another?

Hepatitis A, a highly contagious, vaccine-preventable, fecal-spread viral disease commonly prevalent in countries with poor sanitation and lack of safe food and water, is now rampant in Kentucky.

More than 4,000 known cases, including 40 deaths, have been confirmed in the Commonwealth since the outbreak began in the fall of 2017. This disease, uncommon in the United States before 2016, has become a national public health crisis.

As of February 2018,103 of 120 Kentucky counties had recorded cases of the disease. Eastern Kentucky, with its history of poor water quality and growing at-risk transient and drug-abusing populations, is one of the areas hardest hit with this easily preventable disease.

When the virus appeared in Kentucky, it was vitally important to get people vaccinated to prevent its spread. In spite of the Center for Disease Control recommendation that the first dose of the Hepatitis A vaccine be given to children between 12 and 18 months, with a second dose between 18 months and two years of age in 2005, Kentucky did not begin requiring the vaccination for school-age children until July 2018.

It is difficult to determine how many children are still unvaccinated and at risk. Additionally, most adult Kentuckians have not been vaccinated for the virus.

Our inability to facilitate a successful program to contain this outbreak is a frightening symptom of the Commonwealth’s own public health crisis. Our state public health system has been devastated by funding cuts and a $38 million pension debt.

As a result, local and regional health departments cannot adequately address the issues stemming from our increasingly transient and homeless populations and our unceasing, cataclysmic drug epidemic. At-risk populations are difficult to reach in the best of times. Many of these people live on the street, are immunocompromised and work in our service industries.

Since most infected persons don’t realize they are sick until after they have spread this virus to others, we are all at risk of infection.

It is vital to contain this disease – and equally essential to prevent the future outbreak of others. Prevention being the key.

When the solution is as simple as a highly effective vaccine, we must focus our efforts on providing that vaccine to as much of our population as possible. While the upfront cost of immunization is high, it is significantly less than the high expense of medical care and hospitalization.

Adequate funding of our public health system by the legislature is critical. Public health departments must have the resources necessary to prevent contagious diseases and to ensure that medications, such as vaccines, are not only available but also accessible.

Keeping our high-risk, transient inmate population free from communicable diseases (with adequate health screening, care and vaccines) benefits every member of the communities in which they live. A state-wide clean needle exchange program can decrease the spread of infection and also can be a vehicle for providing vaccination services, testing for contagious diseases and illness prevention education to a high-risk population.

We must ensure that every community has access to a clean water supply and adequate sanitation. Education of all on the importance of thorough and proper handwashing will also help prevent the spread of disease.

State support for, and rapid mobilization of, our volunteer medical reserve corps to assist in stemming disease outbreaks across the state should be a priority. Volunteers are trained and qualified to aid health departments in servicing at-risk and high-risk individuals and families. These populations too often fear our brick-and-mortar health departments. We must bring public health support to at-risk individuals at homeless shelters, recovery programs and even in their homes. And we can.

We must not ignore, become complacent or resign ourselves to these public health crises. If we do disregard these preventable disease endemics, they will become the deadly new normal in the Commonwealth.

Kathryn Hendrickson of Maysville is a writer, lawyer, nurse and former bookstore owner. Email her at kbhendrickson@gmail.com.