What is Hepatitis A? Doctor explains transmission, symptoms, vaccine

Hepatitis A is a fecal-orally transmitted virus, according to Dr. Cynthia Morrow.
Hepatitis A is a fecal-orally transmitted virus, according to Dr. Cynthia Morrow.(MGN)
Published: May. 24, 2022 at 5:04 PM EDT
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ROANOKE, Va. (WDBJ) - Tuesday the Roanoke City Alleghany Health District announced a third Roanoke City restaurant employee tested positive for Hepatitis A. This follows an announcement from earlier in the month that an employee at another restaurant who tested positive handled food prior to it being cooked.

Last year, another restaurant learned only after patrons got sick that an employee was positive for Hepatitis A. Three people died from hepatitis A connected to that outbreak, and dozens more contracted the illness.

So what is Hepatitis A?

Last week we invited Dr. Cynthia Morrow, leader of the RCAHD, onto the WDBJ7+ Digital News Desk to help us better understand the virus.

Dr. Morrow explained that Hepatitis is inflammation of the liver. Hepatitis A is a fecal-orally transmitted virus, whereas Hepatitis B and C are bloodborne. That means you must ingest Hepatitis A to get it or have close, personal contact with an infected person.

“I know this can make people uncomfortable, but hand hygiene is incredibly important and Hepatitis A is infectious. It’s quite infectious. So, let’s say I have Hep A, what happens is I start shedding that virus in my stool, in my poop, about two weeks before I might even know that I have any symptoms. And so anytime I go to the bathroom, if I have any contact between the stool and my hand, I can get it on my hand, if I don’t wash my hands very, very carefully I can then, you know, open a bag of potato chips, dip my hand in the bag of potato chips and then that whole bag of potato chips is now contaminated. So it’s fecal-oral meaning that it goes from our feces, our stool, into our mouths. And I know that is just really unappealing to think about that but that’s the primary mode of transmission.”

In a typical year, the health district would document two to three cases of Hepatitis A. That official count so far is up to 58 since January 1, 2022. About 80 percent of those cases are in individuals identified as injection drug users with Substance Use Disorder. Dr. Morrow explains that in the RCAHD, Hepatitis A is disproportionately affecting people in Roanoke City, between the ages of 30 and 39, who are injection drug users.

“They may be sharing all sorts of other things,” Morrow explains, “....and they may not have access to great hand hygiene, you know, access to sinks and soaps and everything else.”

Common symptoms include fatigue, nausea, stomach pain and jaundice, which is the yellowing of the skin or whites of the eyes. Symptoms can last up to two months.

“One of the complicating things about Hepatitis A is that the incubation period can be a month and even a little bit longer than a month,” she explained.

When it comes to cases involving restaurant workers, Dr. Morrow said it makes a difference whether the employees handled food before or after the cooking process. In the case involving Luigi’s Italian Gourmet Italian Restaurant earlier this month, the RCAHD determined that while the employee was believed to have handled food, it considers the risk to patrons low because the food handled was later cooked. The health district said that this most recent case, involving Tuco’s Taqueria Garaje, was also low risk as the affected individual is not believed to have directly handled food.

“There is an enormous difference in the risk if someone’s touching, let’s say, lettuce that’s going on a hamburger compared to cutting bread that’s going to be toasted in the oven or putting dressing on a chicken that’s going to be cooked,” she explained. “And that’s why we’re so careful with our inspections, making sure things are at temperature and that everything is working properly.”

Dr. Morrow stressed good hand hygiene as one of the most important preventative measures.

“The bottom line here is that good hand hygiene, as much as we all had our parents tell us, ‘wash our hands, wash our hands, wash our hands,’ that’s really the most important way to prevent the transmission of Hepatitis A,” she said.

Dr. Morrow said Hepatitis A vaccines are not required for restaurant workers, but that it is a matter of national debate.

“I think that’s something we do need to take a long and careful look at,” she said. “We require certain vaccines of healthcare workers and I do think there are situations where it would be valuable for us to reevaluate our policies. And I certainly think that, you know, it’s a discussion that I would be very open to having with our legislators if they would like to have that discussion. And that’s from me here in the RCAHD. I do not represent the entirety of VDH and of course that would have to go through our central office, but I would certainly welcome a discussion.”

Because of these two recent cases, the health district offered Hepatitis A vaccines to anyone who ate at the restaurants on specific days out of an abundance of caution and because of the high level of sensitivity to the current outbreak in the community.

“We have a two week window after exposure in which administering hep A vaccine can actually prevent the disease - decreases the risk of getting the disease - if you were in fact exposed,” she explained.

Dr. Morrow says children are most likely already vaccinated because it became routine many years ago. According to the CDC, the vaccine was first licensed as a two-dose vaccine for kids younger than two in 1995. In 1996 and 1999, the Advisory Committee on Immunization Practices recommended routine Hepatitis A vaccines for kids under two in communities with the highest rate of the disease. In 2005, the minimum age was lowered to 12 months and in 2006, the Committee recommended routine vaccination of all kids between 12 and 23 months, regardless of risk category or location.

According to Dr. Morrow, the CDC now recommends the vaccine for children, people who are incarcerated, people who use injection drugs and men who have sex with men as they are the most at-risk groups.

“It’s a two-dose vaccine,” Dr. Morrow explained. “So you get one vaccine and then six months later you get another vaccine. And that’s it, that’s it for the rest of our lives.”

Vaccines are being made available through the RCAHD on a first come-first served basis. If a person seeking a vaccine has insurance, the health district will run it through their insurance. But if someone is uninsured, they will provide the vaccine to them for free.

“I don’t want cost to be a barrier for them to get vaccinated,” Dr. Morrow said.

A representative for the health district told WDBJ7 Monday that officials had distributed more than 150 vaccinations over Thursday and Friday of last week.

Dr. Morrow says people can also check with their primary care provider or a local pharmacy for the vaccine as well.

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