Flagler Health Officials Target Hot Spots to Protect Against 363% Statewide Increase in Hepatitis A

With a 363 percent increase in reported cases so far in 2019 compared with all of 2018, Hepatitis A is striking Florida in a more deadly fashion than in other states, and the situation is getting so bad that Florida is offering free socks and bus passes to encourage homeless people to get vaccinated.

Florida Surgeon General Scott Rivkees, who doubles as secretary of the state Department of Health, told a Senate health care committee Tuesday that 40 people in Florida have died from the virus, giving the state a 1.3 percent fatality rate, compared to the national average of 1 percent.

Florida has had 2,540 reported cases this year of hepatitis A, including 78 last week, according to the latest data posted on the Department of Health website. That is a massive increase over previous years. For example, the state had 122 cases in 2016, 276 cases in 2017 and 548 cases in 2018.

Flagler County has counted eight cases so far this year, according to the Flagler Health Department. Some of the individuals were hospitalized. None have died. Flagler’s tally is a relatively low number, but “our biggest concern is being close to Volusia,” says Gretchen Smith, the local health department’s spokesperson.

Volusia has 229 cases so far this year–third-highest tally in the state after Pasco (391) and Pinellas (358). St. Johns has just seven cases and Duval 16: the epidemic is concentrated in central and south-central Florida.

“We’re trying, we’re out there trying to do more,” Smith said, with Flagler’s efforts dovetailing the state’s, doing outreach “and going after the most vulnerable population for it.”

Hepatitis A is a communicable disease, but it is preventable by vaccine. “It is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water,” according to the Centers for Disease Control. (In 2016, an outbreak was traced to frozen strawberries and raw scallops.) Last year the CDC reported that 68 percent of Hepatitis A cases in the nation were related to drug use, homelessness or both.

“We’ve spent a lot of time going to the jail, we’ve spent a lot of time going to court- ordered drug treatment facilities and programs,” such as Project WARM in Bunnell, and working with agencies and groups, including churches, that help the homeless. The now-dismantled homeless camp near the library used to be “a prime place to do vaccination clinic, but now that they’re more dispersed it’s more difficult to find them,” Smith said.

The health department has administered 355 vaccines in Flagler just since the beginning of July.

A concern with Volusia is that the homeless population tends to move freely between the two counties.

Some 78 percent of the hepatitis A cases in Florida have required hospitalization, compared to 60 percent nationally. Given the average cost of hospitalization in Florida is $77,000, Rivkees said the virus has resulted in an estimated $180 million in hospital charges.

“This has had a serious impact in the state of Florida. We have had 40 individuals who have passed away in the state of Florida,” Rivkees told members of the Senate Health Policy Committee.

The contagious virus can attack the liver and is spread in such ways as oral ingestion of fecal matter. That can happen, for instance, if people don’t wash their hands adequately after going to the restroom.

With the number of hepatitis A cases in the state growing exponentially, Rivkees issued a public health emergency in August and encouraged vaccination, especially for Floridians who are considered at risk or vulnerable to the virus once infected.

“This is a vaccine-preventable condition. So if an individual is exposed to hepatitis A and gets a vaccine within 14 days, it can be prevented,” Rivkees said.

At-risk populations include homeless people and drug users, amounting to about 491,000 people in Florida, according to data from the federal Centers for Disease Control and Prevention. To stop the spread of the virus, the CDC recommends that 80 percent of the at-risk population be vaccinated. That translates to about 392,000 people.

Rivkees told senators the state is actively working with county health departments to get people vaccinated. The vaccinations are voluntary, and Rivkees said the state is offering incentives to entice at-risk people, such as offering free socks and bus passes.

Rivkees said nearly 205,000 people in Florida have been vaccinated against the virus. While Rivkees stressed the role county health departments are playing, data shows that private health providers are taking the lead on vaccinations.

The majority of vaccinations have been administered by providers who aren’t connected with county health departments. County health departments have administered 85,556 vaccinations according to the Department of Health website.

Meanwhile, in addition to working with county officials, the Florida Department of Health has partnered with other state agencies in trying to abate the spread of the virus, including the Department of Business and Professional Regulation, which regulates restaurants.

Rivkees maintained that Hepatitis A is not being spread through restaurants.

Rivkees said the state has made contact with 21 patrons who visited restaurants where someone on staff had a state-reported hepatitis A infection.

“I wish to emphasize that we are currently unaware of any situation where hepatitis A has been transmitted from a food worker to a patron in the state of Florida,” Rivkees told the panel.

–FlaglerLive and News Service of Florida