DETROIT – Over the past year, the hepatitis A virus has been spreading at an alarming rate, and Metro Detroit is among the areas seeing large outbreaks.
The outbreak started in August 2016 and has continued to affect communities in Southeast Michigan. It has prompted public health officials to escalate the effort to contain the outbreak. It's a threat everyone should take seriously.
In Third World countries, hepatitis A is so common that by the age of 10, most children develop natural immunity to it. In the United States, that's not the case for adults because they haven't been exposed to the virus.
People in the United States are susceptible to developing the infection later in life, when the virus hits with much more ferocity.
"In this outbreak, we are seeing severe cases," said Dr. Katherine Reyes, an infectious disease specialist at Henry Ford Hospital in Detroit.
Reyes said she's seen some of the recent cases of hepatitis A.
"The most severe we've had are evaluated for liver transplantation, and we've had cases of death," Reyes said.
There are several viruses that can cause hepatitis, which is the inflammation of the liver, and that might cause some confusion.
"There an alphabet soup of hepatitis A, B and C," Reyes said.
One important difference about hepatitis A is the way in which it's spread. People don't have to be exposed to any blood, as in hepatitis B and C.
"Hepatitis A is spread by ingestion of the virus after having contact with food, drinks or objects that have been contaminated from the virus when it's present in the stool of an infected person," Reyes said.
That makes the virus very contagious in any unsanitary conditions and opens the possibility of it spreading where an infected person handles food. This has caused many alerts to be issued when an infected food handler is identified.
Alerts don't necessarily mean the infection has spread, but because there is risk, people should get protected.
"After being exposed, prophylaxis is to prevent you from developing the hepatitis A infection," Reyes said. "The hepatitis A vaccine and another substance called immunoglobulin are recommended -- most effective within two weeks of having the exposure."
Right now, there are outbreaks in other parts of the country, as well, putting a strain on the available vaccine supply and causing the Michigan Department of Health and Human Services to prioritize publicly purchased adult vaccine use.
The first priority is to immunize people after a potential exposure. The state is also prioritizing other high-risk groups, including men who have sex with men, people with a history of substance abuse, people who are homeless or in transient housing, correctional facility inmates and people with underlying liver disease.
Food handlers, health care workers and anyone else who wants to be protected from hepatitis A are still encouraged to get vaccinated, but right now, they are encouraged to go through their private insurance and primary physicians.
"Hepatitis A vaccine is now universally recommended for age 1 and older," Reyes said.
That's been the case since 1995, so anyone born since then has likely been vaccinated as a child and protected.
Many of the cases in the current outbreak have been very severe, but hepatitis A can cause a wide range of illnesses. That can be a problem, since someone with minimal symptoms, such as a fever or mild nausea, can unknowingly spread the infection.
So far, there isn't a clear source for the current outbreak, and as of last week, there have been 495 cases with 84 percent of people hospitalized and 19 deaths.
Experts stress that because the hepatitis A virus can live on surfaces, washing hands after using the restroom and before eating is especially important to efforts at reducing the spread of the virus.