Map of reported Hepatitis A cases in the Louisville area. | Courtesy of the Louisville Metro Department of Public Health and Wellness

Louisville’s hepatitis A outbreak is showing signs of improvement, but health officials are urging the public to continue to be on guard against the illness that has reached record levels in Jefferson County and around the state.

Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness, speaks on hepatitis A. | Photo by Darla Carter

“I wish I could say that it’s over, but that’s not the case,” Louisville’s chief health strategist, Dr. Sarah Moyer, said during a news conference Thursday. “Unfortunately, Kentucky has the distinction of having the largest outbreak in the nation and Louisville is at around 540 cases.”

There also have been four deaths in the Louisville area and eight across the state.

The good news, though, is that the number of new hepatitis A cases per day has been trending downward locally. They’ve gone from 4.1 cases per day in April to 1.67 cases per day in July, according to the Louisville Metro Department of Public Health and Wellness.

That’s not necessarily a permanent thing, though, so health officials are continuing to urge people to get vaccinated — and to practice good hand hygiene — to avoid the contagious illness, which has primarily affected homeless people and individuals who use illicit drugs.

“This is no time to rest,” said Dr. Lori Caloia, medical director of the Louisville health department.

Doug Thoroughman, of the U.S. Centers for Disease Control and Prevention, praised Louisville’s response to the outbreak, including a communitywide vaccination push by Public Health and Wellness and others, such as the University of Louisville.

“It looks like the numbers are starting to go down, but that’s purely because of the amount of effort they’ve done to get those vaccinations out there,” Thoroughman said. “… I think that’s really good for a city this size.”

However, there are still “too many” people “catching a disease that can be prevented,” said Moyer, director of Public Health and Wellness.

Caloia said there have been clusters of cases downtown, in Portland, near Churchill Downs and in the Dixie Highway corridor as well as Shively, Valley Station and Pleasure Ridge Park. But “there’s no place in Jefferson County that’s not at risk.”

Since last summer, there have been nearly 1,100 cases statewide, said Dr. Jeffrey Howard, Kentucky’s public health commissioner. That’s more than the state’s 10-year average.

But Kentucky is not alone. Thoroughman noted that about 10 states, such as Michigan, California, West Virginia, Ohio and Indiana, also have been hit by widespread hepatitis A and nine are still affected.

Louisville has been the epicenter of Kentucky’s outbreak, but cases have been spreading into more rural parts of the state. That’s where “I have turned my attention to now as a commissioner” in terms of response and prevention, Howard said.

Doug Thoroughman of the U.S. Centers for Disease Control and Prevention praised Louisville’s response to the hepatitis A outbreak. He’s also acting state epidemiologist for Kentucky. | Photo by Darla Carter

Thoroughman, a career epidemiology field officer for the CDC, said jail inmates being transferred around the state has helped to fuel the outbreak. He praised Louisville for making efforts to reach tough-to-reach populations through places like the Louisville Syringe Exchange Program and the county jail.

The illness, which causes inflammation of the liver, is typically spread when people come in contact with foods, beverages or other objects that have been contaminated with the fecal matter of an infected person. It also can be picked up while in close contact with an infected person, such as when being intimate or sharing drug paraphernalia, such as a joint.

But “recently, we’re seeing a growing number of cases of people with no risk factors and have had cases in every single ZIP code here in Louisville,” Moyer said.

Around the state, roughly 15 percent to 20 percent of cases have no apparent risk factors, Howard said, adding that people aren’t always willing to admit they abuse drugs or that someone they live with has that habit.

Also, some people get out of hospital before anyone has had a chance to interview them about their risk factors, Thoroughman said.

Howard complimented Louisville’s health department on its effort to fight the outbreak and to advise others. “They’ve been a vocal advocate for other health departments across the state,” he said.

Hepatitis A vaccine | Courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases

There have been more than 78,000 immunizations throughout the Louisville area, according to the health department, which has done more than 16,000.

Much of that effort has been concentrated on the at-risk population and the food service industry, although health officials said the risk of getting infected by eating out is very low.

“The virus in this outbreak is being passed from person to person from poor hand washing, and we have no current evidence of it being passed by food or drink,” Moyer said.

She added, “Everyone needs to get vaccinated and most pharmacies and health care providers in the area do carry it,” meaning the vaccine.