Effort mounted to find and treat hepatitis C, which is spreading; most people who have it probably don't know they have it

"A multimillion-dollar effort to fight hepatitis C was introduced Thursday in Louisville with the help of Gov. Matt Bevin as well as medical professionals and health advocates," Darla Carter reports for Insider Louisville.

The five-year, five-state project in Kentucky and four other states will use screenings, community partnerships and prevention programs, and strengthen the health-care infrastructure to fight the liver disease, Carter reports. The project, called HepConnect, will serve Kentucky, Indiana, North Carolina, Tennessee and West Virginia.

"We can't afford to ignore it," Gov. Bevin said. (Darla Carter photo)

Many people who have hepatitis C don’t know it because it often doesn't present symptoms, said Derek Spencer, a lobbyist for Gilead Sciences, the drug maker funding the project. The state of Kentucky estimates that more than 40,000 Kentuckians have the disease, but “The actual number is likely four to five times that amount,” said the state Cabinet for Health and Family Services.

The opioid epidemic is spreading the hep-C virus, Spencer said: “The majority of new HCV infections in the Appalachian region are attributed to the results of syringe-sharing practices and other equipment associated with injecting drugs.”

Carter notes, "Other ways of acquiring the virus include sharing personal items, such as razors and toothbrushes; getting a tattoo or body piercing in an unregulated setting; or even sometimes through sexual activity." If the illness goes undetected, it “can progress to liver damage, liver failure, liver cancer and death,” Spencer said.

Research by the federal Centers for Disease Control and Prevention in Kentucky, Tennessee, Virginia and West Virginia showed a 364% increase in the number of acute hep C cases "from 2006 to 2012 among young people, mainly whites living in urban and non-urban areas," Carter notes.

Gov. Matt Bevin said at the announcement that hep C was once considered a chronic disease of baby boomers, but we’ve now seen it “leap into younger generations,” he said. “We can’t afford to ignore it.”

Other at the April 25 event "talked about the need to lessen the stigma surrounding hepatitis C and drug use, and a panel of experts from the University of Louisville Hepatitis C Center and elsewhere spoke of the need to address not only the person injecting drugs but also family members who might be infected or impacted," Carter reports..

“Pregnant women can pass hepatitis C on to their babies,” nurse practitioner Barbra Cave said.

The first year of the project will cost $11 million. "The project is being led by the Harm Reduction Coalition, a national organization that promotes the health and dignity of people and communities affected by drug use," Carter reports. It has a Kentucky branch.

Ky. has half the cases in odd, 5-state outbreak of E. coli infection

Video from The Washington Post

Kentucky has about half of the cases in an outbreak of infections from a strain of E. coli bacteria that has also sickened people in Ohio, Virginia, Tennessee and Georgia. The federal Centers for Disease Control and Prevention said Friday that the source of the 72 infections has not been identified.

The CDC said Kentucky had 36 cases, but the day before, the state Department for Public Health said 46 people in the state had been sickened by the O103 strain of E. coli, which is among those that produce Shiga toxin.  Spokeswoman Barbara Fox said six had been hospitalized. The toxin usually sickens people two to five days after they swallow the germ, the health department says.

"Most people get diarrhea (often bloody), severe stomach cramps and vomiting," The CDC says. "Most people recover within a week, but some illnesses can last longer and be more severe. Talk to your doctor if you have symptoms of an E. coli infection. . . . Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out."

The Mercer County Health Department said in a Facebook post, "These cases have been found in children and teenagers with an extensive exposure to fast food," but added, "The outbreak is not limited to young people."

That report, and the median age of those infected, 17, indicate that “It’s probably some convenience, fast food consumed by kids,” Bill Marler, a Seattle food-safety lawyer, told The Washington Post. "One silver lining, he added, is that people in this age range are typically healthy and not prone to further complications from E. coli," reports the Post's Michael Brice-Saddler.

Still, Marler said it is “concerning” that health officials haven't been able to trace the pathogen to a food source. “Given the size and the number of states that are involved, what you’re seeing is very unusual,” he told the Post. “If it was five people or 10 people, that’s a little harder to figure out. But when there’s 72 people and they’re being interviewed by epidemiologists, it’s pretty unusual you don’t have a culprit. The real question is, what do 72 people have in common over five states? It has to be something.”

"That something, Marler said, is likely a food or water product that people can’t remember they ate," the Post reports. "State and local health officials are required to interview ill patients and determine what they consumed in the week leading up to their symptoms, but recalling one’s dietary choices is often easier said than done, he said. Condiments, garnish, toppings, and spices can all contain traces of E. coli."

Marler said, “That’s probably why it’s taking longer to figure out, because people can’t remember what was in their meal.”

"Citing a CDC data set that dates to 1998, Marler noted outbreaks of E. coli O103 are relatively uncommon. Eighteen such outbreaks have been reported in the United States since 2000, with the highest number of reported illnesses being 29 during a 2010 outbreak in Minnesota. That makes this O103 outbreak by far the largest in recent memory, he said."

The state Department for Public Health says E. coli infections can be prevented by:

• Washing hands frequently for at least 20 seconds with soap and warm water, especially before eating, after going to the bathroom, handling raw meat and eggs, and after handling or petting animals;

• Thoroughly washing produce before eating;

• Thoroughly cooking meat;

• Cleaning and sanitizing food preparation areas;

• Avoiding swallowing lake or pool water;

• Drinking only pasteurized milk;

• Frequently cleaning and sanitizing restrooms, including door knobs and faucets; and

• Reporting diarrheal illnesses to your physician.

More information can be found here: https://www.cdc.gov/ecoli/ecoli-prevention.html.

Resolution to require study of response to hepatitis A outbreak, and recommendations to avoid a repeat, failed in the legislature

Hepatitis A vaccine (USA Today photo by Nikki Boliaux)

The state Cabinet for Health and Family Services won't have to conduct a study of its response to the hepatitis A outbreak that has killed at least 52 in the state and is the nation's worst outbreak of the liver disease. It also won't have to make recommendations to the General Assembly "to ensure that future responses to outbreaks are more effective," as a legislative resolution would have directed.

The Senate-passed resolution directing the study and recommendations wasn't brought up for a vote in the House on the last day of the session, "despite broad bipartisan support," reports Deborah Yetter of the Louisville Courier Journal.

The sponsor of the resolution, Senate Democratic Leader Morgan McGarvey of Louisville, told Yetter that he didn't think it failed because of any opposition to the measure. "Rather, he said, he thinks it got caught in the crush of last-minute legislation that kept members of the House wrangling over other, more controversial bills almost till midnight," he said.

McGarvey said he will "demand answers" about how state officials responded to the outbreak, and Rep. Joni Jenkins, D-Shively, "said she expects lawmakers will pursue the matter with the cabinet," Yetter reports. Jenkins said, "It is a national embarrassment that we've handled it so poorly."

"The Courier Journal reported in February that a slow response over the past year by state public health officials to an outbreak of the contagious liver disease appeared to contribute to what became the the nation's largest and deadliest outbreak," Yetter notes.

Health departments scramble to fight hepatitis A outbreak

Peyton Manning had hepatitis C but didn't know about hepatitis
A or the outbreak until it hit him. (Michael Clevenger, Courier Journal)

The nation's largest outbreak of hepatitis A has slacked off somewhat in Kentucky, but remains a threat and local health departments are dipping into their reserves and taking unusual steps to get people vaccinated for the liver disease, which has killed 44 Kentuckians during the outbreak.

The medical director of the Lake Cumberland District Health Department doesn't usually give vaccinations, but each of her counties only had one or two nurses to do that, so Dr. Christine Weyman started giving shots, too, Laura Ungar and Chris Kenning report for the Louisville Courier Journal.

"She has gone out to vaccinate drug users who largely were spreading the virus," they report. "She once went so far as to chase two men down a street to persuade them to get the shot. (They weren't interested.) She also went to the crowded Pulaski County Detention Center, realizing the 213-bed jail with more than 400 inmates could be an excellent incubator for the virus. Right outside the jailer's office door, her health department placed a refrigerator for the sole purpose of storing vaccines."

"In many ways," Ungar and Kenning wrote, the Somerset-based department "is a microcosm of rural Kentucky's continuing struggle with hepatitis A. What's happening there reflects how Kentucky's communities with limited resources are quietly battling the nation’s largest and deadliest outbreak — learning as they go and altering their strategies to meet the many challenges they face."

The state has averaged 76 hepatitis A cases per week this year, "sometimes reaching more than 90 a week, compared with 151 a week at its peak in early November," the CJ reports, but "Kathleen Winter, an epidemiologist at the University of Kentucky, said a recent downward curve in the outbreak doesn't necessarily mean it's waning."

"We still need robust intervention," Winter told the newspaper. "It's still too early to say whether it’s really winding down. We still have individuals getting sick, being hospitalized and dying."

The story's first example was Peyton Manning, 27, "who was sleeping behind a Walmart in Lexington and spending his days shooting meth and heroin. Late last year, he admitted himself to The Healing Place in Campbellsville. Then a virus hit him. He couldn’t sleep. He couldn't keep any food down." He went to the UK hospital and recovered at his mother's home.

Manning already had hepatitis C, but said he didn't know about hepatitis A or the outbreak. "didn’t even know it was a thing," he told the CJ. "I started to watch the news. It was like, damn, I didn’t know it was that bad."

Health departments are responding "with a mix of resources," the paper reports. "In addition to using state funding, local health departments can also order federally funded vaccine through the state or buy shots using money from $233 million in county health department reserves," which "vary greatly across counties and area development districts. They're in the negative numbers in some places and reach into the millions of dollars in others."

The Lake Cumberland agency had unrestricted reserves of about $5 million when the outbreak hit in 2017, but was "trying to avoid using this as much as possible to help with the pension crisis," said Ron Cimala, its administrative director. Many health departments have said they will have to close unless the legislature keeps giving them relief from the state's new requirement for funding their employees' pensions.

Ranges of health department reserves that could be used to pay Kentucky Employees Retirement System obligations. About half of the counties are in district departments; others are independent.

Bevin says he exposed his nine children to chickenpox, pooh-poohs required vaccinations, misstates who requires them

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin said in a radio interview that he exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky.

Bevin also cast doubt on longstanding government policy of requiring vaccinations, and incorrectly attributed the requirement to the federal government rather than the state. His administration recently made it easier for parents to exempt their children from school vaccination requirements.

Bevin raised the topic on Bowling Green's WKCT, where the hosts had been discussing a lawsuit by a Northern Kentucky teenager who had been barred from playing basketball, and then from school entirely, because he had not been vaccinated for chickenpox. Host Chad Young asked Bevin about bills he might veto, but the governor said he first wanted to talk about chickenpox.

Gov. Matt Bevin

“Every single one of my kids had the chickenpox," Bevin said. "They got the chickenpox on purpose because we found a neighbor that had it and I went and made sure every one of my kids was exposed to it, and they got it. . . . They were miserable for a few days, and they all turned out fine.”

Bevin and his wife, Glenna, have nine children, ages 5 to 16, according to his campaign website.

The U.S. Centers for Disease Control and Prevention strongly discourages such "chickenpox parties," saying they are not worth the risk.

"Chickenpox can be serious and can lead to severe complications and death, even in healthy children," the agency warns. "There is no way to tell in advance how severe your child’s symptoms will be. So it is not worth taking the chance of exposing your child to someone with the disease. The best way to protect infants and children against chickenpox is to get them vaccinated."

Dr. Sean McTigue, a pediatric infectious-disease specialist at the University of Kentucky, told Kentucky Health News that the efficacy and safety of vaccines has been proven "time and time again."

McTigue, who teaches pediatrics, said "chickenpox parties" might have made sense before there was a vaccine against the disease, because its risks after infancy increase with age, and some parents wanted to make sure they got it while they were young. But in the post-vaccine era, he called such parties "ludicrous." The vaccine for chickenpox was licensed for use in the U.S. in 1995.

Centers for Disease Control and Prevention graphic
For a larger version, click on it.

Before that, the CDC reports, about 4 million Americans got chickenpox each year, over 10,500 were hospitalized and about 100 to 150 died.

Chickenpox is a highly contagious infection caused by the varicella-zoster virus that causes itchy, blister-like rash. Most children who get chickenpox recover completely, as the governor's children did, but the CDC says it can be "serious, even deadly, especially for babies, adolescents, adults, pregnant women, and people with a weakened immune system."

Shingles a risk

McTigue pointed out that a person who has had a natural chickenpox infection is at a greater risk than a vaccinated person of getting shingles, a painful skin rash that is caused by the same virus that causes chickenpox.

During the radio interview, Bevin said that vaccinating children should be a parent's decision, not the government's.

"If you are worried about your child getting chickenpox or whatever else, vaccinate your child. . . . But for some people, and for some parents, for some reason they choose otherwise," he said. "This is America. The federal government should not be forcing this upon people."

The federal government does not force states to require vaccination, only recommends it, a CDC spokesperson said. The National Conference of State Legislatures says all 50 states have laws requiring specific vaccines for students; 47 grant religious exemptions and 18 allow philosophical exemptions.

Kentucky only allows medical and religious exemptions. Chickenpox is among the diseases for which the state requires proof of vaccination, or medical documentation that the child has had it, in order to enter public kindergarten.

In 2017 the Bevin administration made it easier for parents to invoke the religious exemption to the law that requires vaccination to attend school. The new rules allow parents to download a form, have it notarized and submit it to their school upon enrollment, instead of having to get a signed form from a health-care provider.

Following that, Kentucky's rank among the states in the percentage of children with vaccinations declined, and Spectrum News reported that the number of Kentucky parents claiming the religious exemption increased 59 percent in the 2017-18 school year.

A representative of the state Cabinet for Health and Family Services told a legislative committee in 2017 that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider's signature; and that parents and guardians were having trouble finding providers to sign the forms.

'Herd immunity' requires mandatory vaccinations

Bevin's assertion that governments shouldn't require vaccinations doesn't take into account the principle of "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. Some are not because their immune systems are too weak to allow them to be vaccinated, or because they are too young to be vaccinated.

People with weakened immune systems include those with cancer, especially if they are being treated with an aggressive chemotherapy, people who have had bone-marrow transplants, people who have had an organ transplant, people with auto-immune disorders, like rheumatoid arthritis or Lupus, or people with acquired immunodeficiency syndrome, or AIDS.

"Those people are absolutely reliant upon herd immunity because we can't immunize them," McTigue said. "The only way that we have to protect them is to ensure that everybody around them is immunized so that the chances of them actually coming into contact with somebody who has one of these very infectious viruses or bacteria is very, very low."

He said herd immunity is vitally important to protect babies, because they can't be vaccinated for measles, mumps and rubella or chickenpox until they are a year old because these vaccines are made with very weak, but live viruses.

"So, every single baby less than one year old is unvaccinated and unprotected against those conditions," he said. "And the young babies who cannot yet be immunized against those conditions are exactly the patients that we worry about the most if they get those infections because they are at greatest risk of complications." He added, "A varicella infection to a newborn baby can be fatal."

It should also be noted that parents who chose to not get their children vaccinated also depend on herd immunity to keep their children healthy. But the practice puts others at risk, McTigue said.

"Not only does it put your child at risk of getting severe and potentially life-threatening illnesses, but it also puts other people in the community at risk of getting serious and potentially life-threatening infections," he said.

The case that set the stage

After a chickenpox outbreak at Assumption Academy, a Catholic school in Boone County, the Northern Kentucky Health Department on March 14 told students without proof of vaccination or immunity against chickenpox to not attend school until further notice, and their extracurricular activities were canceled.

Jerome Kunkel, an 18-year-old senior at the high school who has not been been vaccinated, filed suit against the department, claiming "health officials violated his freedom of religion and other rights by ordering students without the vaccine to not attend school or extracurricular activities," Max Londberg reports for the Cincinnati Enquirer. The suit says Kunkel opposes the vaccine on religious grounds "due to its being derived from aborted fetal cells."

The vaccine was developed in the 1960s with cells from a legally aborted fetus, but no aborted fetuses being used today, McTigue said. He said the Catholic Church supports the vaccine.

In response to Bevin's comments, the Kentucky Democratic Party called on the governor to clarify his position on vaccination against the hepatitis A virus, which has killed 44 people in the state.

“Kentucky is currently experiencing the worst outbreak of hepatitis A in the country. It is a major public health risk at this point. The last thing we need is Governor Bevin suggesting that immunization is not important," the party said on its website. "Governor Bevin should reassure the public that he supports the recommendation of the entire medical community with respect to controlling an outbreak of Hepatitis A, which is immunization.”

The governor's office did not return a request for further comment. Bevin, a Republican, is running for re-election this year; his running mate is state Sen. Ralph Alvarado, a Winchester physician who has publicly endorsed vaccinations.

Governor says he exposed his 9 children to chicken pox, says vaccines aren't for everyone; expert says we're not in 17th century

https://www.courier-journal.com/story/news/politics/2019/03/20/matt-bevin-exposed-kids-chickenpox-instead-vaccine/3221848002/
For a recording of this part of Bevin's interview with WKCT Radio in Bowling Green, click here. A full Kentucky Health News story will appear later.

Surge by a stronger strain of the flu is another warning that the season for the disease is not over; shots still available and useful

"Though influenza activity typically peaks by February’s end, the flu season isn’t over – and a harsher strain called H3N2 has increased in circulation both nationwide and in Kentucky," reports Caroline Eggers of the Bowling Green Daily News.

“Some people may think flu season is over, but it is not,” Glynda Chu, spokeswoman for The Medical Center at Bowling Green, told the Daily News in an email. “Many people in our area are suffering with the flu and we encourage everyone to please get a flu shot.”

Among the four types of flu viruses, "influenza A accounts for the majority of cases and is the only strain that is divided into subtypes, which are most commonly H1N1 and H3N2," Eggers notes. "Although the H1N1 virus has predominated this flu season, the H3N2 virus accounted for nearly half of influenza A detected nationally through the week of Feb. 16. In Kentucky and the Southeast, the H3N2 virus is considered predominant."

That calls for caution because H3N2 causes more greater number of hospitalizations and deaths in children and the elderly, according to the Centers for Disease Control and Prevention. The CDC recommends getting a flu vaccination even at this point, because the flu season won't end until May.

"Other methods of protection include frequent hand washing, especially before eating or touching the face, and avoiding touching public surfaces," Eggers notes. "If you suspect the illness, remain home from work, school or errands to prevent further spread, and consider getting tested at the hospital and starting antiviral medications. But mostly, the best treatment is plenty of rest and drinking lots of water."

Ky. officials rejected infectious-disease chief's plea to move faster against hepatitis A outbreak, now nation's largest and deadliest

As part of a package of stories about Kentucky's hepatitis A outbreak, which is the "worst this century, sickening nearly 4,100 and killing 40," Laura Ungar and Chris Kenning of the Courier Journal write that the "state could have done more to control it."

In an April 2018 e-mail obtained by the Louisville newspaper, Dr. Robert Brawley, the state's infectious-disease chief at the time, wrote to his health department colleagues: "Need to move faster. The virus is moving faster than we and [local health departments] are … immunizing persons.”

"Brawley argued that a powerful state response was needed: $10 million, including $6 million for a fusillade of 150,000 vaccines and $4 million for temporary health workers to help administer them. In an email, he also lobbied for a public health emergency declaration to bolster the case for more federal money," Ungar and Kenning report. "His urgent pleas went nowhere. And in the months that followed, Kentucky’s outbreak metastasized into the nation's largest and deadliest."

The Courier Journal found that Brawley's "aggressive recommendations" were rejected by his boss, 31-year-old acting Health Commissioner Dr. Jeffrey Howard. Now Kentucky's death toll from this outbreak is the highest in the nation.

"Amid limited state budgets, county staffing constraints and the availability of more than $220 million in local health-department reserve funds — he stuck instead to a $3 million state response," the CJ reports. "The state ultimately sent $2.2 million to local departments and declined to declare an emergency. In addition, county health departments added little to no staff to increase efforts to find and vaccinate drug users and homeless people."

Ungar and Kenning report that Kentucky "never tried strategies used successfully by some of the other 15 states who fought outbreaks with limited budgets," like seeking money from the state legislature, deploying "strike teams" of state health workers to counties, and immediately deploying state funds for the epidemic.

The article details the decision-making process of Howard, who stood by his decisions, though he did acknowledge that in retrospect he could have done some things differently.

"I wish I would've been more bold and said, 'Let's move into Eastern Kentucky,' as opposed to waiting, as we did," said Howard, who grew up in Appalachia. "As an Eastern Kentucky guy, it's heartbreaking to see this disease spread out in rural Kentucky. And I knew the struggles that they'd have once it started."

Adam Meier, secretary of the Cabinet for Health and Family Services, told the reporters that he stood by Howard's choices, saying in a statement that the "challenges Kentucky faced were less financial and more logistical in nature as it related to identifying and engaging the at-risk populations. While hindsight might provide more context for some things now, in retrospect there’s not a single decision that I’m aware of that was made in real time, with the information available at the time, that I would change."

But Brawley, who resigned in June, told the Courier Journal that much greater resources were needed to battle Kentucky's spread of hepatitis A and called the state's response "too low and too slow" for what has become "the worst hepatitis A outbreak in the United States in the 21st century."

He added, "Had the state hastened its vaccination efforts, it may have more quickly reduced the risk of the disease's spread and prevented acute cases, hospitalizations for about 50 percent of those cases, deaths and avoided millions of dollars in healthcare expenses for emergency department visits and hospitalizations."

Ungar and Kenning reported that several others in the health department agreed with Brawley's recommendations, including nurse Margaret Jones, manager of the state's immunization program. "We should have done more sooner," said Jones, who retired last summer. "If we had been able to get the vaccines out early, we may not have near as many cases or near as many hospitalizations. … He knew what to do. I think his advice should have been heeded."

Now, state health officials are hopeful the hepatitis A outbreak has crested. The number of new cases each week is down from 150 in early November 2018, averaging 87 a week this year. Officials said their plans in 2019 include "working to help local departments vaccinate more regularly at jails, increase vaccinations generally, enlist more federally qualified health centers to administer vaccines, and continue to push out federally funded vaccine to counties," the CJ reports.

The newspaper published four other articles on this topic on the same day.

Ungar tells the story of an Eastern Kentucky woman who learned she had hepatitis A, along with her existing hepatitis C, while getting treatment for her heroin and methamphetamine addiction. Another story covers how other states have responded to the outbreaks of the disease, reporting that since 2017, 16 states have had outbreaks, infecting more than 13,000 people. Another details how hepatitis A spread across Kentucky.

The final story, written by Kenning, chronicles the story of an Appalachian woman with a heroin addiction who said she didn't know about the highly contagious virus, and even if she had, she wouldn't have cared. "People who are addicted like myself, I really didn't care if I lived or died. So I (wouldn't have) really cared if I was infected with it," she said.

Flu cases hit a new high for the season in the state's latest report; season runs through May, so shots can still protect your family

The number of influenza cases confirmed in Kentucky hit the highest level of the season, by far, in the week ended Feb. 2, according to the latest surveillance report from the state Department for Public Health.

Kentucky Department for Public Health chart

The department's laboratory confirmed 1,876 cases that week, for a total of 7,285 in the season. All 17 health regions of the state have confirmed cases, and only one region did not confirm a case in the week that ended Feb. 2. Eleven regions reported increased influenza-like illnesses, and 12 reported increased flu activity, suggesting that a new season high may yet be recorded.

Two more flu deaths were reported in the week ending Feb. 2, raising the season total to 21. All but one have been over the age of 18, but among the department's 10-year age groups, children under 10 had many more cases than any other group.

Flu is very contagious and is especially dangerous to small children, the elderly, and those who have chronic health conditions. It is caused by a virus that spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.

Persons who develop symptoms should contact their medical provider immediately to determine if they are a good candidate for treatment with an antiviral drug, which could shorten the course of the illness or reduce its severity.

Flu season runs through May, and immunization takes full effect about two weeks after vaccination, so officials urge those who haven't been vaccinated to get a flu shot.

Hepatitis found among three more Lexington-area food workers

Lexington Herald-Leader graphic

Three more restaurant workers in the Lexington area have been found to have hepatitis A, but the state still has no food-borne cases of the disease more than 15 months into a statewide outbreak of then liver disease, health officials said.

"Anyone who ate in November at the Hardee’s at 2990 Richmond Road in Lexington, the Waffle House at 2347 Buena Vista Road in Lexington or the Waffle House at 4 Carol Road in Winchester may have been affected," Morgan Eads of the Lexington Herald-Leader reports, based on information from the Lexington-Fayette County Health Department.

The department said in a news release, “While it is relatively uncommon for restaurant customers to become infected with the hepatitis A virus due to an infected food handler, anyone who consumed food or drink at these locations during the stated time period is advised to get a hepatitis A vaccination.” It said the three employees won't return to work until they are medically cleared.

Hepatitis A can be transmitted from person to person by food or water contaminated by fecal material. Symptoms include fatigue, stomach pain, nausea, darkened urine and yellowed skin. The health department recommends getting vaccinated for the disease and carefully washing hands with warm water and soap after using the bathroom, and before making food and drinks.

Through Nov. 17, the outbreak had affected 2,769 Kentuckians, hospitalized 1,438 and killed 17, according to the state Cabinet for Health and Family Services.

Frankfort fast-food restaurant closes for cleaning after one employee is found to have hepatitis A

A Frankfort fast-food restaurant closed for cleanup after one of its employees was found to have the liver disease hepatitis A, usually caused by ingestion of fecal material.

“The risk of infection from this food-service worker is very low due to hand-hygiene requirements at Hardee’s and all eating establishments,” Franklin County Health Department Director Judy Mattingly said in a news release.

Top of health department news release

The restaurant, at 1248 South US 127, "voluntarily closed . . . for a thorough cleaning and sanitizing after being notified," and ensured that all employees received a hepatitis A vaccination immediately, said the release, posted on the department's Facebook page.

The department later posted, "Prior to Oct. 4 the food service worker was in roles wearing gloves, or roles where there was no contact with food. So, the minimal risk of exposure occurred on Oct. 4. Any concerned community member should get a hepatitis A vaccine before Oct. 18."

"It’s the 22nd case of the virus in Franklin County during the ongoing outbreak in Kentucky — called the worst in the nation," Josh Bergeron of The State Journal reports. "From Aug. 1, 2017, to Sept. 22, 2018, the latest available numbers, the hepatitis A outbreak in Kentucky numbered 1,851 cases, with 1,029 hospitalizations and 14 deaths. In Franklin County, there had been 21 total cases reported as of Sept. 22. A majority of the reported cases in Kentucky have been linked to illicit drug use." 

Hepatitis A can cause fatigue, loss of appetite, nausea, fever, stomach pain, brown urine, light-colored stools, and yellowing of the eyes or skin or eyes. People may have some of these symptoms or none of them; a person can transmit the disease without showing symptoms, and can become ill from the virus up to seven weeks after being exposed to it.

The disease "usually spreads when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person," the news release said. "The virus spreads when an infected person does not wash his/her hands adequately after using the toilet, or engages in behaviors that increase risk of infection."

The federal Centers for Disease Control and Prevention recommends the hepatitis A vaccination for the following groups:
• All children at age 1
• Travelers to countries that have high rates of hepatitis A
• Family members and caregivers of recent adoptees from countries where hepatitis A is common
• Men who have sexual contact with other men
• People who use injection and non-injection illegal drugs

• People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C

State's hepatitis A outbreak is worst in nation, but seems to be fading in Louisville, which feds say is 'gold standard' for response

Kentucky’s hepatitis A outbreak is now the biggest outbreak in the United States. As of July 7, the outbreak had struck 65 of Kentucky's 120 counties with 1,094 hepatitis A cases and eight deaths. But federal officials say Louisville is a national example for how to respond to an outbreak, reports Phillip M. Bailey of the Courier Journal.

Epidemiologist Rui Zhao meets with others at Louisville Metro
Health and Wellness. (Courier Journal photo by Marty Pearl)

As of July 17, Louisville had 540 cases and four deaths. While the liver disease continues to spread around the state, there is evidence that it may be declining. "It feels like we’re coming out of it," Rui Zhao, epidemiologist for the Louisville Metro Department of Public Health and Wellness told Bailey.

"New reports of hep A infections reached as high as 4.1 cases per day in April," Bailey reports. "Since then, that figure has plummeted to about 3.8 in May; 2.5 in June; and 1.67 in July."

Officials of the U.S. Centers for Disease Control and Prevention came to Louisville July 21 to praise the health department's work, WDRB-TV reports: "Louisville has set the gold standard for responding to the hepatitis A outbreak and set standard for the rest of the country," CDC epidemiologist Doug Thoroughman said.

Since the outbreak was declared on November, the Louisville health department has vaccinated more than 78,000 people by focusing on homeless camps, health clinics and the jail. "It also has an aggressive campaign to shake the general public's consciousness that they, too, can catch the disease," Bailey reports. "About 10 percent of Louisville's hep A diagnoses aren't in those high-risk groups, according to health officials."

State and local officials urge everyone in Kentucky that is part of the outbreak to get vaccinated. They also reminded everyone to practice good hand hygiene, particularly after using the restroom and before eating or preparing food.

Health officials stressed the virus in the outbreak is being passed person-to-person. There has been no evidence that it is being spread by food or drink as was the case during the hepatitis A outbreak that struck Louisville in 1988. However, "Louisville restaurants have taken the lead by vaccinating their staff," Bailey reports.

WKYT-TV map; for interactive version, showing the number of cases per county, click here.

Boyd County and Ashland, its largest city, "recently passed measures requiring all food service workers to be vaccinated against the virus," and adjoining Greenup County "is poised to join them," reports Will Wright of the Lexington Herald Leader. "Boyd County has one of the highest infection rates of hepatitis A per-capita in the state, with 134 reported cases since August 2017." Greenup has had 46 cases; Carter County, which adjoins them both, has had 85.

While the outbreak leads the nation, Dr. Jeffrey Howard, commissioner of the Kentucky Department for Public Health, said “Our surveillance and the fact that we’ve hospitalized about 60 percent of all cases has kept our death rate below that of other states experiencing hepatitis A outbreaks.”

Illnesses and possible flu outbreaks close schools for the week

Several counties throughout Kentucky have closed schools for the remainder of the week due to multiple illnesses "in response to what public health officials are calling a possible flu outbreak among young people," Austin Ramsey and Bobbie Hayse report for the Messenger-Inquirer in Owensboro. Butler, Ohio and Todd County schools announced their closings Tuesday, just after two- and three-day closures in Muhlenberg and Hancock County, respectively. "Barbourville, Jenkins, and Williamsburg Independent Schools, along with Knox, Clay, and Mercer Counties all closed on Thursday," WKYT reports.

Jessica Austin, an epidemiologist with the Green River District Health Department, told Ramsey and Hayes that "tests in Ohio County seem to be pointing to seasonal influenza, a contagious respiratory illness caused by a group of related viruses that can be of real concern to high-risk populations such as the elderly or young."

February is typically the height of most flu cases, Ramsey and Hayse write. "Persons can protect themselves somewhat with an annual vaccine that the U.S. Centers for Disease Control and Prevention reports indicate is a good match for common strains seen in patients this year. Austin said it remains unclear whether patients treated for influenza in the region received vaccines within the last six months."

Austin says that almost all local health providers confirm influenza using 'rapid flu tests'-- mouth or nasal swabs that can yield results within 15 minutes -- but "CDC officials warn that the quick tests often produce false-positive results and that their sensitivity hovers somewhere between 50-70 percent," Ramsey and Hayse write.

It's too early to raise any public health crisis alarms, so Austin "is now calling on all local hospitals and clinics in the seven-county region to send test samples to the Kentucky Department for Public Health for more accurate results."

"That's the only way we're going to tell if this really is influenza, what kind it is and how widespread the problem really is," she said.

"But officials with One Health Infectious Disease, which is monitoring flu cases at Owensboro Health facilities in all of western Kentucky and southern Indiana, said there were 113 confirmed cases of flu in the region in January and already 69 in the first seven days of February, representing what one official called a 'significant jump' in a short period of time," Ramsey and Hayse write.

Officials in Mercer County told WKYT that the decision to close was a proactive one. "Attendance numbers started to decline throughout the week with many parents saying their children were sick. Many teachers and members of the staff were also ill. Mercer County school leaders say they will spend the next two days disinfecting each classroom and building," WKYT writes.

"Everything that kids are coming in contact with. Desks, water fountains, door knobs, light switches, all those things. So all the surfaces that they clean regularly anyway, but this is just a more thorough, deeper cleaning," Esther Hayslett, the director of pupil personnel, told WKTY.

Disinfecting classrooms isn't the only solution. Dr. Katrina Hood, a doctor with Pediatric & Adolescent Associates in Lexington, told WKYT: "I think as best we can trying to teach kids during the winter about the triangle in the face; So your eyes, your nose, your mouth, try not to touch those during the day."

Updated February 10, 2017 at 2:43pm

Vaccinations aren't just for children; coalition encourages shots for college students

Photo from southtexasmed.com

By Danielle Ray
Kentucky Health News

"Getting your shots" is part of starting to school, but it's also supposed to be part of the drill at the University of Kentucky, the University of Louisville and Kentucky State University.

The Kentucky Immunization Coalition, a public-private partnership, has mounted an effort to make sure students at those and other schools get immunized.

U of L began requiring all incoming freshmen to be vaccinated for diseases including hepatitis B, tuberculosis and meningitis in 2014.

UK requires only the meningitis vaccine for incoming freshmen living in campus housing. However, university health officials strongly recommend all other routine childhood vaccines, including those that protect against illnesses such as measles, mumps, rubella, chicken pox, polio, diphtheria, tetanus, pertussis, hepatitis B, hepatitis A and human papillomavirus.

Students in health-profession colleges at UK who train and work in hospital settings must have additional vaccinations, including those that protect against hepatitis B, chicken pox and season flu.

Phillip Bressoud, executive director of campus health services at U of L, said the ultimate goal is effective outbreak management.

"Over several years, we'd had situations where we'd had either an outbreak of tuberculosis or chicken pox, and when that happens it's really difficult to assess who is vaccinated or unvaccinated, and who we need to notify," Bressoud told Lisa Gillespie, of WFPL in Louisville.

Bressoud says managing an outbreak includes telling unvaccinated students what to avoid in order to keep it contained.

Potentially toxic ingredients from formaldehyde to aluminum can produce adverse effects in vaccines, especially if a person is allergic to an ingredient used in the vaccine. Any vaccine can cause side effects. For the most part, though, side effects are minor, such as a sore arm or low-grade fever, and they typically go away within a few days, according to the federal Centers for Disease Control and Prevention.

At least 14 counties had vaccination rates in 2011-12 below level experts say is needed to protect kindergartners from measles

As concern about the spread of measles from lack of vaccination grows, many Kentucky counties probably have vaccination rates below the minimum that experts say is needed to create "herd immunity" and prevent spread of the highly contagious disease among students in kindergarten.

At least 14 Kentucky counties had measles vaccination rates below 90 percent in the 2011-12 school year, according to state data analyzed by USA Today, in a survey of states that track vaccination rates and make them public. The Courier-Journal published the Kentucky figures in an online database.

The counties under 90 percent were Bath (89%), Boyle (83%), Bullitt (88%), Christian (89%), Harlan (88%), Jefferson (86%), Laurel (85%), Lawrence (88%), Lee (80%), Nelson (82%), Robertson (88%), Rowan (86%), Taylor (82%) and Webster (86%). Data from several counties was not available. For the database with county-by-county figures, click here.

The statewide vaccination rate was 93 percent, pulled down by a rate of 86 percent in Jefferson County, the state's most populous. The lowest rates were 80 percent in Lee County and 82 percent in Nelson and Taylor counties.

Jefferson County officials told The Courier-Journal that the county's rate rose above 90 percent in the last two to three years. Bullitt County school-health coordinator Lesa Bodine told the Louisville newspaper that her data show 94.3 percent of the county's kindergarten students "have been properly immunized," The C-J's Darla Carter reports. "However, she said there are some parents who choose not to immunize their children. She also noted that there can be a delay in receiving proof of vaccination because a child has, for example, transferred from another county or state."

Like many states, Kentucky allows parents to exempt their children from required vaccinations for medical or religious reasons. Measles outbreaks in other states have been blamed at least partly on parents who still believe discredited reports that vaccines cause autism or other disorders. Generally, the stricter the laws, the higher the vaccination rate, Stateline reports. Here's a Stateline map showing how states differ:

Chickenpox outbreak reported at Crab Orchard

Five students at Crab Orchard Elementary School in Lincoln County have been diagnosed with chickenpox, putting the county school system on alert, Ben Kleppinger reports for The Interior Journal in Stanford. Eva Stone, the schools' health coordinator, told the newspaper that the students had been diagnosed with by at least four health-care providers, and an unknown number of siblings under school age have also been diagnosed.

"A letter was sent home to Crab Orchard parents earlier this week, notifying them of the diagnoses and informing them on how to identify the symptoms," Kleppinger reports. "The letter encouraged parents to make sure their children are vaccinated against chickenpox and warned that people with chickenpox should avoid contact with others who have not had the illness or the vaccination. The chickenpox vaccination is about 80-85 percent effective after one dose, so a second vaccination is routinely recommended, according to the letter."

Diabetics have increased risk of complications from flu

Certain groups of people, including diabetics, are at risk of serious flu complications each year, according to a report from the University of Alabama at Birmingham.

More than 500,000 Kentuckians, over 11 percent of the state’s population, are living with diabetes, wrote R. Stewart Perry and Larry Smith, co-chairs of the American Diabetes Association's national board of directors, in an op-ed piece in The Courier-Journal.

“Diabetes can weaken your immune system against the flu, and it also puts you at an increased risk of flu-related complications,” Fernando Ovalle, M.D., professor of medicine in the UAB School of Medicine and senior scientist in the UAB Comprehensive Diabetes Center, said in a news release. “The weakening of the immune system makes it harder for your body to fight the flu virus. Being sick can also raise your blood glucose and prevent you from eating properly. You are also at risk of flu-related complications like pneumonia.”

 There are several things Ovalle said diabetics and parents of diabetics can do to give some protection from the virus:
 • Get a flu vaccine shot. The nasal spray vaccine is not safe for people with diabetes.
 •Talk to your health care provider about the pneumococcal vaccine. It will help protect against pneumonia.
 • Keep track of blood glucose. It can be affected by illness.
 • Wash your hands often with soap and water or an alcohol-based hand rub.
 • Try to avoid close contact with sick people.
 • Practice the good-health habits like getting plenty of sleep and exercise, managing stress, drinking plenty of fluids and eating healthy food.

 For diabetics who think they have the flu, Ovalle suggests these steps:
 • Contact a health care provider immediately. Symptoms include fever or feeling feverish or experiencing chills, cough, sore throat, runny or stuff nose, muscle or body aches, headaches and fatigue. In children, vomiting and diarrhea can be common.
 • Continue taking diabetes pills or insulin.
 • Test blood glucose every four hours and track results.
 • Stay hydrated; drink lots of calorie-free liquids.
 • Try to eat normally.
 • Weigh every day. Losing weight without trying is a sign of high blood glucose.

“Be vigilant and smart, especially when it comes to washing your hands." Ovalle said. "And if you every have any questions or concerns, contact your health care provider.” (Read more)

Lexington internist, Dr. Ardis Hoven, becomes president of the AMA, the nation's largest physician organization

Ardis Dee Hoven, M.D., an internal medicine and infectious disease specialist in Lexington, was installed as president of the American Medical Association at its annual meeting Tuesday night in Chicago. The AMA is the nation's largest physician organization.

Dr. Hoven is a graduate of the University of Kentucky medical school, and she has served in numerous leadership position for the AMA, including her first presidential term in 1993-94. Hoven has also served at the UK’s Bluegrass Care Clinic, which treats infectious diseases including HIV/AIDS, reports Business Lexington.

The AMA is headquartered in Chicago, and since 1847 it has aimed "to promote the art and science of medicine and the betterment of public health," says its website. Furthermore, the organization's strategic focus is aligned with many of the health care issues now facing Kentucky, which are improving health outcomes, accelerating change in medical education and enhancing the sustainability of medical practice.

Kentucky's week-long brand of flu now called 'widespread'

What started out early is now full-blown. The Kentucky Department for Public Health informed federal health authorities this week that data it has received from local health departments, hospitals, clinics and private doctors indicates that flu is now "widespread" in the state.

Darla Carter of The Courier-Journal reports that Louisville officials have confirmed nine cases and 127 positive rapid tests since the first week of November. For the status to be "widespread," the state explained it had received numerous reports from throughout the commonwealth. What is being reported is not a 24-hour bug, but a 7-10 day virus.  Health officials are vigorously encouraging flu vaccinations. (Read more)

Southern Kentucky circuit judge was probably the first to die in Tenn. from fungal meningitis outbreak stemming from tainted steroids

Judge Eddie C. Lovelace

The first person to die in Tennessee from the nine-state meningitis outbreak liked to bad steroids was most likely Kentucky Circuit Judge Eddie C. Lovelace of Albany, 78, who died at Vanderbilt University Medical Center Sept. 17. John Dreyzehner, Tennessee's commissioner of health, said Friday that the number of Tennesseans affected by the meningitis outbreak has now risen to 29. The number of deaths is unchanged at three. The search for more affected patients will continue "for some time," he said. Investigators haven't found evidence that the clinics or clinicians in Tennessee did anything to cause the outbreak, which has been reported in other states.

In July and August, Lovelace received three rounds of the pain-relieving steroid injections suspected of causing the outbreak of the rare disease, Joyce Lovelace, his wife of 55 years, told Adam Tamburin of The Tennessean. Representatives of the Saint Thomas Hospital Outpatient Neurosurgery Center, where he received the injections, are reported to have called Joyce Lovelace twice after his death to discuss his condition. They did not mention the outbreak, she said, nor have they confirmed that that was his cause of death.

Vanderbilt spokespeople have confirmed to the newspaper that "the first reported casualty of the outbreak was a 78-year-old man who died there on Sept. 17." Doctors told his family that his unexpected death was likely caused by a stroke, which is common among critically ill meningitis patients. His symptoms -- slurred speech, trouble walking and numbness -- are consistent with symptoms of fungal meningitis.

Lovelace had been a circuit court judge for two decades, and commonwealth's attorney and county attorney before that. “He always wanted to be known as a judge who knew the law, and he certainly was.” Joyce Lovelace said. “His career was not over. He had years yet to work.” (Read more) Democratic Gov. Steve Beshear may fill Lovelace's nonpartisan vacancy with state Sen. David Williams of Burkesville, who has been president of the Senate since Republicans took formal control of the chamber in 2000.

UPDATE, Oct. 6: The New York Times reports that nine states have reported meningitis cases connected to the steroids made by a Massachusetts company, which shipped the steroids to 14 other states. "Some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies." (Read more) New England Compounding has recalled the steroids, The Tennessean reports.