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Hepatitis A outbreaks have hit several states — here's what you need to know

A recent series of hepatitis A outbreaks in several states across the country have government officials so concerned about public safety that some are declaring states of emergency.

Back in the 1980s, hepatitis A was somewhat common in the United States. But according to a May 2019 report from the Centers for Disease Control and Prevention (CDC), between 1996 and 2011, rates of hepatitis A cases nationwide declined by 95%. However, between 2016 and 2018, reports of cases increased an astounding 294%, compared to the prior three years. Nine states and Washington, D.C. saw increases of around 500%.

This year, the number of hepatitis A cases in the U.S. continues to grow at an alarming rate. With 23 states currently experiencing an outbreak, 22,566 cases have been reported to date, nationwide, up from 10,582 last year. The national death toll from hepatitis A in 2019 is at 221.

Described by the CDC as a “communicable disease of the liver,” hepatitis A involves symptoms that typically include fatigue, low appetite, stomach pain, nausea, and jaundice. People experiencing it can even have yellow-colored eyes and skin. Fortunately, the illness — though quite unpleasant — is not a permanent condition, as symptoms subside over the course of a couple months. The body’s newly produced antibodies also prevent future infection, but the best way to prevent initial infection is through vaccination. Adults can receive vaccinations anytime, while the CDC recommends children aged 1 get inoculated.

Hepatitis A is “usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water,” the CDC says. That’s part of the reason you see signs in restaurant bathrooms telling its employees they must wash their hands before returning to work. Recent outbreaks of hepatitis A were tied to frozen strawberries imported from Egypt, raw scallops in Hawaii, and pomegranates from Turkey. But when the CDC reported on the nationwide surge in cases between 2016 and 2018, they saw increases especially “among men who have sex with men, and primarily, among persons who report drug use or homelessness.”

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Philadelphia has been one of the hardest-hit urban areas, with about 117 reported cases in 2019 alone. The city usually experiences no more than six hepatitis A cases annually. Local experts blame fecal matter in the streets and parks for the public health emergency, and the city is working on deploying public bathrooms and washing stations to prevent further spread.

In Florida, 2,034 hepatitis A cases have been reported this year. For comparison, only 106 cases were logged in 2014. Last year, the state saw 548 cases, which was thought to be extraordinarily high, but this year’s figures prompted the Florida Surgeon General to declare a public health emergency on August 1, according to the Miami Herald. Health officials in one Tampa Bay area, Pinellas County, which has reported the second-most hepatitis A cases of any county in the state, have sent workers out into the streets to vaccinate people, targeting individuals living in homelessness who are most at-risk. A local hamburger chain closed three locations after the health department publicized one of its workers’ positive hepatitis A status, and set up a makeshift vaccination clinic.

Similar stories have been reported in Ohio, with a Little Caesar’s employee testing positive, and in Tennessee, where a McDonald’s worker in Johnson City is feared to have exposed more than 500 customers to the disease.

Other states experiencing a hepatitis A outbreak include Illinois, Mississippi, Washington, and Missouri. Officials are asking people to get vaccinated and take greater precautions, including vigorous and frequent hand-washing, to prevent its spread.

Though many officials are concerned with the outbreaks, there are recent examples of sweeping government efforts containing them. Within the past year, the California and Utah governments successfully defeated hepatitis A outbreaks in their states. In both cases, the disease was affecting homeless communities most.

In Salt Lake City, where Utah’s outbreak was most concentrated, the County Health Department’s workers “set all boots on the ground,” according to Desert News, patrolling the streets to identify potential carriers and at-risk individuals, offering treatment and vaccines. For its efforts, the Salt Lake County Health Department was named the United States’ “Local Health Department of the Year” by the National Association of County and City Health Officials.