- Hepatitis A is especially deadly for people with HCV.
Given the widespread infection of HCV as well as HBV, and HIV a multistate
outbreak is very serious.
- Patricia Doyle
- A ProMED-mail post www.promedmail.org ProMED-mail is
a program of the International Society for Infectious Diseases www.isid.org
-  Date: Tue 30 Sep 2003 From: ProMED-mail <email@example.com>
Source: Asheville Citizen Times, Mon 29 Sep 2003 [edited] http://cgi.citizen-times.com/cgi-bin/story/buncombe_news/42661
- North Carolina: Hepatitis Scare May Be Part of Multistate
- State and federal health officials are concerned the
cases of hepatitis A virus infection in Buncombe County could be part of
a multistate outbreak. Dr. Jeff Ingle, head of the Communicable Disease
Control Program for the North Carolina Division of Public Health, said
hepatitis outbreaks also have occurred in Tennessee (see  below) and
Georgia (see  below), and officials are investigating whether affected
restaurants had common food suppliers.
- "The other connection could be with these multi-day
camp-out rock festivals," Ingle said. "Food preparation is largely
unregulated and the sanitation can be less than ideal." The Centers
for Disease Control and Prevention have issued a warning about the outdoor
festivals featuring various "jam bands." Information on the CDC
Web site says 26 cases of hepatitis A virus infection have been reported
among residents of 10 states.
- Officials also are concerned about diners who don't live
in the area and may not know they've been exposed. Alerts have gone out
to every state department of health, Ingle said, but it's impossible to
reach everyone. Dwight Butner, owner of Vincenzo's in downtown Asheville,
and President of the Asheville Independent Restaurant Association, hopes
the outbreak won't affect tourism as foliage season approaches. "But
the main concern here is the health of our workers and patrons," he
said. "Whether people stay away is certainly a concern for business,
but that will pass as soon as the outbreak is over. All we can do is make
sure we're all extremely vigilant about hygiene and food handling issues
and hope this is the end of it."
- Dr. Susan Mims, medical director of the Buncombe County
Health Center, is concerned with containing the outbreak here. So far,
10 cases have been recorded in Buncombe County, all related to food handlers
at Doc Chey's Noodle House and Laughing Seed Cafe. People who ate at either
of those restaurants between 16 and 21 Sep 2003 are urged to go to the
health center for free immune globulin shots. So far, the health center
has administered more than 3000 shots.
- Immune globulin only works to prevent hepatitis A virus
infection for 2 weeks after exposure, so anyone exposed before 16 Sep 2003
who has not had a shot should watch for symptoms - fever and chills, fatigue,
nausea, vomiting, diarrhea, and jaundice (yellowing of the skin and eyes).
Symptoms can appear any time between 15 and 50 days after exposure. "The
best prevention is hand-washing," Mims said. "Frequent and thorough
hand-washing. I can't emphasize that enough."
- However, once the virus is in food, hand-washing won't
help, Ingle said. Cooking will deactivate the virus, but there's still
danger in salads, and raw shellfish can carry the virus no matter how clean
the food handler is. The only way to get permanent protection is with the
hepatitis A vaccine, which is administered in 2 doses 6 months apart. Ingle
said inoculating everyone who works in a restaurant isn't feasible because
the rate of employee turnover is so high. "It's a fairly transient
population," he said. "There's been talk of requiring all food
handlers to be inoculated for a long time, and we asked Duke University
to do a feasibility study in the mid-1990s. That study found it just wasn't
economically sound." However, some restaurants and catering businesses
do offer to pay for hepatitis A vaccine shots for their workers. Eventually,
Ingle said he expects the hepatitis A vaccine to become a common childhood
- More information on hepatitis A virus infection is also
available from the Centers for Disease Control and Prevention at <http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm>
- [Byline: Leslie Boyd]
- ******  Date: Tue 30 Sep 2003 From: ProMED-mail <firstname.lastname@example.org>
Source: Tennessee Department of Health, Thu 18 Sep 2003 [edited] <http://www2.state.tn.us/health/Newsreleases/091803.htm>
- Tennessee: Cluster of Hepatitis A Cases - Free Medication
- A cluster of hepatitis A cases has been confirmed among
workers at O'Charley's Restaurant, located in the Turkey Creek retail development
in West Knoxville. People who ate uncooked foods at this restaurant may
be at risk for developing hepatitis A. Specifically, persons who ate salads
and other uncooked food items, or who drank iced drinks may have been exposed
to the virus.
- Medication called immune globulin may prevent infection
or diminish the severity of the illness, but only if it is given within
2 weeks of exposure. Persons who ate high-risk food items should receive
an injection of immune serum globulin if their exposure occurred between
5 Sep and 14 Sep 2003. Investigators have determined that there was no
exposure in the restaurant after 14 Sep 2003.
- Because there was a University of Tennessee football
game in Knoxville on 6 Sep 2003, a large number of people from outside
the Knoxville area may have eaten at the restaurant and will need to be
treated. Individuals potentially exposed on 5 Sep 2003 must receive immune
globulin by Fri 19 Sep 2003 in order for the medication to be potentially
effective; those exposed on 6 Sep 2003 must receive immune globulin by
Sat 20 Sep 2003.
- The Knox County Health Department is offering free shots
of immune globulin for people who live in the Knoxville/East Tennessee
area, and the Tennessee Department of Health will offer shots for individuals
who ate at the restaurant but who live in other areas of the state. The
medication is free of charge.
- ******  Date: Tue 30 Sep 2003 From: ProMED-mail <email@example.com>
Source: Atlanta Journal Constitution, Sat 27 Sep 2003 [edited] <http://www.ajc.com/metro/content/metro/0903/27hepatitis.html;COXnetJSessionID=
- Georgia: Hepatitis A Outbreak Sparks Inquiry
- Health officials are investigating a hepatitis A outbreak
in Georgia, to see whether the cases have a common link. At least 116 cases
of the liver disease have been reported since 1 Aug 2003, more than double
the number in August and September of 2002.
- In an average year, Georgia records about 400 cases of
the disease, usually spread by eating food contaminated with infected stool.
Restaurants and food distributors are potential sources. An outbreak in
Knoxville this month was traced to a restaurant. A food handler at a restaurant
in Asheville, North Carolina (see  above), recently acquired hepatitis
A, prompting hundreds of patrons to get shots to prevent the disease. Georgia's
cases could be connected to those outbreaks, officials say.
- The Centers for Disease Control and Prevention is looking
into the cases in Georgia, North Carolina, and Tennessee, spokesman Dave
Daigle said. The CDC did not provide further details. One possibility is
a phenomenon the CDC reported in other states this summer: clusters of
young attendees of outdoor "jam band" concerts contracting the
disease, possibly from poor sanitary conditions.
- No cause has been identified for the Georgia outbreak,
and the cases appear to be spread around the state, Richard Quartarone,
spokesman for the Georgia Division of Public Health, said on Fri 26 Sep
2003. "We're starting to do some very aggressive investigating to
see what in the world may be going on. We're trying to focus on combinations
of geography and behavior." Georgia health officials are asking patients
where and what they have eaten and whether they have been to any large
events. Since people don't become ill until about a month after they are
infected, investigations are difficult.
- Health officials also are working with organizers of
this weekend's Blue Ridge HarvestFest in LaFayette, a jam and folk music
gathering just south of Chattanooga, to encourage frequent hand washing,
Quartarone said. No specific problem has been identified with the festival
or the music groups involved.
- Byline: David Wahlberg
- -- ProMED-mail <firstname.lastname@example.org>
- Patricia A. Doyle, PhD Please visit my "Emerging
Diseases" message board at:
Zhan le Devlesa tai sastimasa Go with God and in Good Health
- From Patricia Doyle, PhD
- Hello, Jeff - It is about time researchers looked into
HCV spread via saliva. We discussed this many years ago when you brought
up that question. Think of all the people who have contracted HCV over
those years. Of course, HCV spreads more easily then previously thought.
Just look at the numbers of infected. They certainly all aren't doing
IV drugs or having illicit sex.
- Hepatitis C is a flavivirus. Flaviviruses are by nature,
vectored viruses. I am wondering how long it will take before we hear
that HCV can, in some cases, be spread via mosquitos.