Reining in the hepatitis A outbreak southern Indiana and Louisville area

Due to a limited supply, the Clark County Health Department is able to offer vaccinations only to the uninsured and high-risk populations, such as jail inmates and the homeless.

But work is underway to implement a program that would allow for more widespread vaccinations, including those with insurance. 

"The framework is there," said Clark County health officer Dr. Eric Yazel. "We're still about 10 days out or so from being able to do that."

Food workers at four restaurants in Southern Indiana tested positive for hepatitis A in April, prompting officials in Clark and Floyd counties to urge vaccinations against the virus among certain populations. Louisville also is struggling with an influx of cases, which is magnified as hundreds of thousands of people have descended on the area for Kentucky Derby festivities.

With employees of the three Southern Indiana restaurants — Bob Evans on State Street, Tomo Japanese Steakhouse on Charlestown Road in New Albany, Taco Bell at LaFollette Center in Floyds Knobs and Arby's on Indiana Avenue in Sellersburg — confirmed with hepatitis A, a kind of mass panic can grip the public, Yazel said. So far there have been no food-borne cases of the virus in Clark or Floyd County.

But, Yazel said, health officials work quickly to inform the public of potential exposure.

"Our concern is that can always change," he said of food-borne cases. "We try to be as transparent as possible to the general public, and try to educate and deal with the aftermath."

That "public panic" spurred Dr. Jeffrey Howard, Kentucky's acting commissioner of the Department of Public Health, to issue a statement Thursday stressing that it is safe for people to travel to Kentucky for Derby activities. No cases in Kentucky have been linked to food contamination.

"Let me say that it is safe to travel to Kentucky and it is safe to attend the Kentucky Derby ... We have not had any cases associated with contamination from a food worker and the risk of contracting the disease from an infected food worker is very low," Howard's statement read in part.

In Clark and Floyd counties, the thrust is to vaccinate high-risk populations as defined by the Centers for Disease Control and Prevention. In total, Floyd County has doled out 1,600 vaccinations. Unlike Clark, Floyd offers vaccinations to those with insurance, as well as the non-insured.

The hepatitis A cases in both counties have been contained to household contact with those infected.

"We're not seeing a random person with no known risk factors becoming positive," Yazel said.

Floyd County, which has had 28 confirmed cases of hepatitis A since early February, with two more potential cases under investigation, established an education outreach program for the food service industry, which has been highly successful, so much so that more classes have been added, according to Floyd County Health Officer Dr. Tom Harris. 

"We've actually had a fairly good response, not only with the staff of the health department, but also the community in general," Harris said. "We haven't had the hysteria that Louisville has had. I think there's been a nice community response of people asking the right questions. Overall, things have gone well."

Clark County has 34 confirmed cases of hepatitis A. No restaurant-related cases have come up since a statement was released April 27 about the Arby's employee. Yazel's focus is to vaccinate the homeless and inmates, with first responders and health care workers also being a target.

"Getting a vaccine supply and getting the state help us with vaccinations has been the biggest roadblock there," Yazel said. "We're continuing to work on that the best we can."

Vaccinations make a difference. A hepatitis outbreak at the Clark County jail in mid-March has been tamed after the county received vaccination assistance from the state. Anyone entering the jail's general population receives a shot.

"We haven't had any new cases confirmed through jail transmission in weeks," Yazel said. "And we're talking about the most difficult population to try to contain it."

The success with curbing the outbreak at the jail gives Yazel confidence that the same measure would help with the general public.

"My thoughts are if we increase the percentage of the vaccinated population," he said, "we'll hopefully start making some headway."