Hepatitis outbreak is declining in Ky., but we are still finding more in a week than we once got in a year; 57 have died from it in state

The good news about hepatitis in Kentucky is that the number of hepatitis A cases is dropping. The bad news is that there are still as many cases each week as were once seen in a year's time, and the state is by the far the leader in deaths from the liver disease.

According to the state's weekly report, the number of hepatitis A cases in Kentucky has dropped to around 20 per week for several weeks, a huge improvement from the height of the outbreak in the last months of 2018, when more than 100 new cases were being reported every week. But before the outbreak, which was declared in November 2017, the state averaged about 20 cases a year.

Since August 2017, the report shows that 4,621 Kentuckians have been diagnosed with hepatitis A and 2,233, or 48% of them, have been hospitalized. The primary risk factors for getting this highly contagious disease remains illicit drug use and homelessness.

The 57 deaths reported in Kentucky account for about one-third of the 170 deaths reported to the Centers for Disease Control and Prevention since 2016 in 22 states. "West Virginia and California, by comparison, each has had 21 deaths in their outbreaks. Michigan has had 28, and Indiana 4," Chris Kenning reports for the Louisville Courier Journal.

Four Kentuckians died from the disease in the week ending May 4, says the latest state report. It notes that deaths are identified through periodic reviews of death records and includes anyone who dies with documentation of hepatitis A as a contributing factor to the death -- even if it wasn't the primary cause of death, which is often the case among drug users.

Hepatitis A has been diagnosed in 108 of the state's 120 counties, with 15 reporting new cases in the week ending May 4.

The state's initial response to the outbreak has been criticized for not being aggressive enough.

Kenning notes that a Courier Journal investigation found that the state's former infectious-diseases chief, Dr. Robert Brawley, "recommended $6 million for vaccines and $4 million for temporary workers to help thinly staffed local health departments deliver vaccines to hard-to-reach drug users. He also called for a public health emergency declaration to help pave the way for federal assistance. Instead, Department for Public Health Commissioner Dr. Jeffrey Howard, citing limited funding and the local reserves that some health departments had, sent $2.2 million in state funds to local health departments and declined to seek an emergency declaration."

Howard and other state officials have defended their actions, citing that logistical challenges were greater than a need for more money as the outbreak spread to rural Kentucky.

Brawley, who was allowed to resign in lieu of being fired on June 4, 2018, has maintained his position that the state has not acted aggressively enough. (Since Brawley left, the state has fired Dr. John Bennett, who had been the state's infectious-disease manager since last fall.)

"The Kentucky public should be outraged about the slow-motion public health response that has caused the hepatitis A outbreak to continue into 2019," Brawley told Kenning on May 14. "I am saddened that 57 Kentuckians have died after developing acute hepatitis A and where hepatitis A was a risk factor for their deaths."

In late March, a legislative measure directing the state to review its response to Kentucky's outbreak failed to pass. The Cabinet for Health and Family Services has said it plans to review its response.

Meanwhile, the state has hired a roving team of nurses to administer vaccines in rural county jails and the state is providing more vaccine storage equipment, money and expertise to a handful of currently hard-hit counties, Kenning reports.

Specifically, Kenning reports that the Pulaski County Jail has been vaccinating its jailers, and that the state health department has awarded $46,000 to Jessamine, Bell and Christian counties, which had requested extra support; and that a roving team of nurses will soon be in the Lake Cumberland area.

"The department is continuing to coordinate with local health officials to ensure that resources are available and prevention efforts continue," Howard said in a statement to the Courier Journal on Tuesday. "We want to reiterate that though cases are declining, this is not a time to be complacent. Rather, we must continue to promote prevention including appropriate hygiene practices and vaccination."

Brawley said, "While the number of reported cases has fallen in recent weeks, I expect that the Kentucky hepatitis A outbreak will continue for at least six more months and will have a total of more than 5,000 cases before the outbreak is declared over."