Hepatitis A Outbreak June 2013…That’s a Lovely Shade of Yellow you are Wearing!

Doris Dimmitt, Carson Tahoe Health Hospital Epidemiologist

As most of you probably already know, the Nevada State Health Department sent out a press release late Friday informing the public of a Hepatitis A outbreak in several states, including Nevada. The culprit has been identified as frozen berries purchased at Costco and possibly other retailers in our area. The CDC is working closely with the States involved and so far at least 30 cases of acute Hep. A have been identified.  In Nevada, there are six confirmed cases in the South (Las Vegas area) and two in North (Washoe County). The number of cases will rise during the next couple of months or so.

Outbreaks are always scary and information both good and bad is flooding the community. So let’s all take a deep breath and look at the facts:

Hepatitis A is usually caused by the ingestion of contaminated food or water. So we are looking at a “food poisoning thing” here not a bloodborne pathogen transmission disease like Hepatitis B or C. Poor bathroom hygiene from people with Hepatitis A causes most of the outbreaks in the United States.  In third world countries, entire water supplies can be contaminated due to poor or no sewer systems. It comes from the poop mostly.  So I will wait while you do the visual … say “YUCK”…. and we will move on.

Hepatitis A can’t survive to be well cooked, but it can survive being frozen.  Hence the contaminated frozen berries present themselves as the source of the outbreak. Fresh produce and undercooked meat can also harbor the virus, but don’t seem to be involved in this case.

The symptoms of Hepatitis A are nausea, vomiting, diarrhea, body aches, low-grade fever and then you turn a lovely shade of yellow. The yellow comes from bilirubin in the blood and tissue due to the liver damage hepatitis causes. This yellowing or jaundice appears in the skin and the whites of your eyes. Urine also appears to be dark yellow as your body works overtime to clear the excess bilirubin from the system. The symptoms appear 15-50 days (on average) after the initial exposure to Hepatitis A.  Some people have mild symptoms and the disease may never even be diagnosed, and some people get very sick and even die from the infection.   This is serious, so pay attention, please.  The CDC states that 1 out of 5 people with Hepatitis A will require hospitalization to manage the symptoms, mostly dehydration, and there are 3-6 deaths per 1,000 cases that should be expected.  Normal healthy people can usually fight off the infection on their own. Remember this is a virus so antibiotics won’t help. The bad news is (as if any of this is good news) if you catch a good case Hepatitis A, you can pretty much expect to feel like doo-doo for up to a month. This virus hammers the liver and when the liver don’t feel good, you don’t feel good.  You will recover as your liver recovers. Hepatitis A is transmitted to others by close personal contact so if you catch it, you should expect your family members could get it too. The virus is in the poop, and the poop gets around.

So… last week you know for a fact you ate a whole bag of the mixed berries now known to be contaminated with Hepatitis A, what can you do about it?  First, if there are any leftovers, GET RID OF THEM….NOW.  As in…stop reading this and go do it! Then contact your health care provider and get the Hepatitis A vaccine.  The vaccine has high reliability for preventing the infection if you get it within 2 weeks of the exposure. If you don’t have a primary care physician, call your local health department. They have lots of vaccines.

If you are unlucky enough to catch this beast, call your physician for further instructions. They may want to see you in the office or send you to the ER. If the symptoms are mild, they may just want to keep an eye on you for a while. Blood tests can confirm the diagnosis. Treatment is usually supportive and to ease the symptoms. Please do not come to work – Hepatitis A can spread quickly.

For more information, go to www.cdc.gov, ask a question in the comment section, or email [email protected] to contact Doris Dimmitt, Carson Tahoe Health Hospital Epidemiologist.