10th annual hepatitis conference to be held July 27 in Lexington

By Melissa Patrick
Kentucky Health News

Kentucky, which has one of the nation's highest rates of hepatitis C infection, will hold its 10th annual Viral Hepatitis Conference next week, on the day before World Hepatitis Day.

The conference, hosted by the Kentucky Rural Health Association, will look back at hepatitis over the last 10 years, and make some predictions for what the next decade may hold. It will run from 7:30 a.m. to 5:30 p.m. July 27 at the Embassy Suites on Newtown Pike in Lexington. 

After the conference, from 6 to 8 p.m., there will be 10-year celebration dinner and awards ceremony and dinner. All who attend the conference are invited. 

Each conference session will evaluate the key question asked in the conference title, "How Far Have We Come, and Where Do We Go From Here?"  

The morning sessions will include discussions of HIV (human immunodeficiency virus) in Kentucky, including screening, referral and resources; and an introduction to PrEP (pre-exposure prophylaxis), medicine that can reduce a person's chance of getting HIV from sex or injection-drug use.  

Afternoon sessions will offer a national and a statewide view. The conference will also include sessions that take a look at hepatitis D, perinatal hepatitis B, hepatitis C projects in Kentucky, and pregnant women and children with hepatitis C, and explore drugs and interventions available to treat the disease. 

Click here to register for the conference. The cost to register is $50 before July 20. After that date, the cost increases to $75.  Click here for more information and the agenda. 

In 2020, the latest data available on the Centers for Disease Control and Prevention website, the rate of reported cases of acute hepatitis C in Kentucky was 3.2 cases per 100,000 people, more than double the national rate of 1.5 per 100,000. Kentucky ties with Utah for the sixth highest rate in the nation.

There is no vaccine for hepatitis C, so all adults should get tested

Photo by jarun011, iStock/Getty Images Plus

By Takako Schaninger

University of Kentucky  

The hepatitis vaccines you receive as a child don’t protect you from getting hepatitis C, a serious disease that can have fatal consequences including liver damage, cirrhosis and liver cancer.

Hepatitis is an inflammation of the liver most often caused by three viruses: hepatitis A, hepatitis B and hepatitis C. There is a vaccine for hepatitis A and hepatitis B, but not for hepatitis C. . 

Most people who get hepatitis C develop a chronic, long-lasting infection that sometimes doesn’t present symptoms for months or even years, meaning they can unknowingly spread the virus to others.

Millions of Americans have hepatitis C, yet many don’t know they are infected. The only way to know for sure is to get tested.

The infection is transmitted mainly by blood-to-blood exposure. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment used to prepare and inject drugs.

The Centers for Disease Control and Prevention estimates that 2.4 million people in the U.S. have chronic hepatitis C, with Kentucky having some of the highest infection rates in the country.

The CDC recommends that all adults get tested for hepatitis C. Getting tested is important to find out if you are infected and get lifesaving treatment. Treatments are now available that can cure most people with hepatitis C in eight to 12 weeks.

Hepatitis C is easily preventable. 

For people who inject drugs, the best way to prevent hepatitis C is to stop injecting. Drug treatment including buprenorphine can lower your risk for hepatitis C since there will no longer be a need to inject. 

If you are unable or unwilling to stop injecting drugs, there are steps you can take to reduce the risk of becoming infected including using new, sterile equipment for each injection and avoiding sharing equipment with others.

Kentucky has 82 syringe exchange programs in 63 counties. Click here to find their locations and hours. Here's a map:

Kentucky Cabinet for Health and Family Services map

6 children in 5 Ky. counties have hepatitis from unknown cause(s)

Photo from healthline.com

By Melissa Patrick
Kentucky Health News

Six cases of hepatitis from an unknown cause have been reported in Kentucky, in children between 8 months and 4 years old.

The cases, which are under investigation, have been reported in these counties: Jefferson, with two possible cases; Todd, Lyon, Bourbon and Meade, Sarah Ladd reports for the Louisville Courier Journal. 

Hepatitis is an inflammatory condition of the liver that is usually caused by a viral infection. The Centers for Disease Control and Prevention says it is not unusual for the cause of hepatitis in children to remain unknown, but a growing number of cases has prompted an investigation. 

Nationally, health officials are looking into 274 potential cases of hepatitis with unknown origin in children in 39 states, according to the latest CDC data. 

Health Commissioner Steven Stack said Thursday that while the cause is unknown, the cases are not related to the common causes of hepatitis or Covid-19 and could possibly be linked to the Type 41 adenovirus, which he described as a common virus that causes cold and flu-like symptoms.  He said two of Kentucky's six cases have been linked to the adenovirus.

And while there is no cause for alarm at this time, Stack said families with children who have yellow skin and eyes, vomiting and diarrhea and abnormal blood tests should seek medical care from a pediatric specialist in a timely fashion. 

"This is not something for you to panic about, or to get excessively alarmed about but it is something for you to be careful about," he said.

He added that while it's important to get a diagnosis, there is no specific treatment for adenovirus and that severe cases could require hospitalization or ongoing evaluation from a pediatrician. 

Stack said parents need to be aware that these are illnesses that can spread through the respiratory system or through body fluids and to take precautions. 

"So for parents right now, the important thing is to constantly educate and train children to wash your hands, cover your cough, and make sure they're vaccinated for all preventable diseases through the pediatricians office or the health department. And just to pay careful attention their child," he said. 

There have been 650 probable cases of hepatitis with unknown cause in children in 33 nations between April 5 and May 26 and at least 38 of them needed liver transplants and nine of them died, according to the World Health Organization. 

Stack said none of the six children in Kentucky with this condition have needed liver transplants.

Viral Hepatitis Conference July 27; Ky.'s rate is double U.S. rate

Kentucky will hold its eighth annual conference on viral hepatitis on July 27, the day after World Hepatitis Day. 

"Hepatitis in Kentucky: The Role of Professionals in Hepatitis Elimination" will be hosted by the Kentucky Rural Health Association and will run from 7:30 a.m. to 5:30 p.m. at the Griffin Gate Marriott Resort in Lexington. 

The agenda for the event has not been released. Click here for more information and to register. Continuing education credits will be offered to medical professionals. 

In 2019, the latest data available on the Centers for Disease Control and Prevention website, the rates of reported hepatitis C infections in Kentucky were 2.9 cases per 100,000 people, more than double the nationwide rate of 1.3 cases per 100,000 people. 

45 share recovery stories in Addiction Recovery Week in Wolfe County, nation's most vulnerable to disease outbreaks from drugs

Tinley Creech, Darian Creech, Connie Campbell and Ashton Burks pose after doing the virtual 5K as part of Wolfe County Addiction Recovery Week. All are in the same household. (Photo provided)

By Katie Pratt
University of Kentucky

Recovering from drug addiction can take many years with many bumps in the road along the way, as Wolfe County resident Dena Brooks can attest. Brooks has been in recovery for nearly six years. Today, she stays busy raising her daughter and working as the director of the Wolfe County senior citizens center.

“My life is finally where it should be now,” she said. “I have a new home, a new job and am very involved with the community.”

But getting to this point in her life was not easy. For years, Brooks used pills and then progressed to meth. She went to federal prison for nine months on a drug conviction. After her release, she sought help at a drug treatment center so she could regain custody of her daughter. After leaving the center, she stayed sober for three years before she relapsed. She was arrested on another federal drug charge but has since had her conviction overturned. Since then, she has been determined to stay sober.

“Drugs do not discriminate,” she said. “If my story can help one person, it is worth telling.”

Brooks was one of 45 Wolfe County residents who shared their drug recovery stories as part of Wolfe County’s Addiction Recovery Week, organized by the Wolfe County office of the University of Kentucky Cooperative Extension Service, Wolfe County Schools Family Resource and Youth Services Center and the Agency for Substance Abuse Policy.

During the week, the organizations hosted in-person and virtual events to celebrate those in their community who are recovering from drug addiction and to provide them with resources to support their continued sobriety.

“It was such a positive thing to see somebody finally caring about recovery and praising people who are in recovery,” Brooks said. “No one has done anything like this for Wolfe County before.”

Wolfe County (Wikipedia map)

Wolfe County is consistently one of the state’s poorest counties and faces many drug-related issues with little resources. It leads the nation for the vulnerability of its population to an outbreak of HIV or Hepatitis C because of the opioid epidemic and a lack of a local syringe exchange. In 2018, it had one of the state's highest per-capita rates for drug arrests.

Alyssa Cox, family and consumer sciences extension agent, had been working with her extension colleagues Heather Graham and Jessica Morris and community partners to create the recovery week prior to the pandemic. While the pandemic changed how they delivered their programming, it did not change the week’s focus.

“The goal of this week was to bring awareness to the challenges of addiction recovery and to rally behind our local residents who fight this battle every day,” Cox said.

One of the week's highlights was the opportunity for people in recovery to share their stories and personal photos during a Facebook Live event. As their stories were told, Morris, the county’s 4-H youth development agent, lit a sparkler in their honor.

“Often, you hear about the drug busts or people saying, ‘That’s just another drughead.’ It is so nice for extension to show us that they care and brag on us,” said Tosha Turner, who also shared her recovery story during the event. “It really means a lot.”

Turner has been in recovery for four years. She was addicted to pills and meth. Her drug addiction led her to robbery. She sought treatment after going to jail for her first felony.

“I was as bad as they come, because I didn’t care about anyone or anything when I was on drugs,” Turner said. “If I can recover, anyone can do it.”

She said her daughters are the reason she stays in recovery. Since she has been in recovery, she has worked and saved money to purchase a car. She is now going back to school to become a nurse.

In addition to sharing local recovery stories, extension and its community partners offered socially distant yoga in the park. Individuals in recovery received vouchers for 10 free yoga sessions, thanks to the Agency for Substance Abuse Policy. Each participant also received a free yoga mat.

Graham, who is Wolfe County’s extension agent for agriculture and natural resources, spearheaded a countywide road cleanup in which participants received a cleaning kit and could clean any road in the county they chose.

The extension office also hosted a Recovery Run, which was a virtual 5K that individuals could participate in to honor someone in recovering from addiction. Race participants received a free T-shirt and resources related to substance use and addiction that they picked up through an extension drive-thru event. The Agency for Substance Abuse Policy also offered a free, drive-thru Narcan training for anyone interested.

Cox said due to the success of the week, extension plans to host the event again in 2021.

Transport and fears of stigma and lack of confidentiality biggest barriers to accessing rural syringe exchanges, study concludes

Counties in study are in red; click on the image to enlarge it.

By Heather Chapman
Kentucky Health News

Rural residents who inject drugs say they are less likely to access syringe exchange programs because of transportation problems, inability to get to the service at times it's open, and concerns about stigma, lack of confidentiality, and law enforcement. So says a newly published study examining barriers that can prevent people who inject drugs (PWIDs) from accessing syringe service programs (SSPs) in Appalachian Kentucky.

The researchers surveyed 186 PWIDs who used their local health department SSPs in three rural counties in 2018: Clark, Knox and Owsley (though Clark is in a metropolitan area, much of it is rural). Kentucky leads the nation in the number of SSPs, partly because it has 120 counties. As of July 2019, it had 52 SSPs that aim to reduce the spread of HIV and hepatitis C by giving PWIDs clean needles and disposing of dirty ones, and often offer more information about addiction treatment services when the person is ready.

Among the study's participants, 53.2 percent were male, 92.5% were non-Hispanic whites, and 78.5% had Medicaid coverage. About 39% said they injected more than one drug; methamphetamine was the single most popular drug, with 45.2% reporting it as the primary drug they inject. The next most popular was non-prescribed buprenorphine, which is sold legally as Suboxone for drug treatment (25.8%), followed by heroin (16.1%), other non-prescribed opioids (11.3%), and various other drugs (1.6%).

The biggest barrier to SSP use was the lack of transportation, with 18.3% reporting it as the primary barrier. Other barriers were: inability to access the program during operating hours, which are often limited (12.9%); concerns about stigma, privacy, and/or law enforcement (9.1%), not enough syringes (5.4%); and the location of the program (4.8%).

Participants' concerns varied based on the degree of their county's rurality. In Clark and Knox counties, the least rural, transportation was the most frequently cited barrier. But in Owsley, the most rural county, fear of stigma and lack of confidentiality ranked highest.

Rurality also factored into participants' consistency in accessing the SSPs. Participants in Knox and Owsley were more likely to consistently use the program than participants in Clark. The researchers believe the more consistent uptake in rural areas is because people in rural areas tend to have higher residential stability. However, Clark County participants may be less likely to consistently use SSPs because they're more likely to have an alternate means of accessing clean needles.

The study is part of a larger National Institutes of Health-funded effort to learn about SSP uptake in rural areas. This study's authors recently published another study about PWIDs in the same three counties, focused on what kind of interventions are most effective and which drug users are most likely to seek treatment.

Conference speakers call for a more aggressive approach to eliminate hepatitis; Ky leads the nation in both hepatitis A and C

By Melissa Patrick
Kentucky Health News

Elimination of the three main types of hepatitis is possible, but will require a more aggressive approach that includes increasing vaccinations for hepatitis A and B and universal screening, non-restricted access to treatment and increased access to harm-reduction programs for those with hepatitis C.

That's been the unwavering message about the liver disease for the the last few years at the Kentucky Rural Health Association's annual Viral Hepatitis Conference, and it was again at the one held July 31 in Lexington.

Meanwhile, Kentucky leads the nation in both acute and chronic cases of hepatitis C and has the largest outbreak of hepatitis A in the nation, and how the state has managed these highly contagious liver diseases has come with both kudos and criticism.

Hepatitis C

Kentucky is often praised for its progressive response to hepatitis C, a chronic disease that is estimated to affect about 43,000 Kentuckian.

But about half of people with hepatitis C don't know they have it, according to Dr. Neil Gupta, chief of the Epidemiology and Surveillance Branch in the federal Centers for Disease Control and Prevention's Division of Viral Hepatitis.

Kentucky is recognized nationwide for its embrace of syringe-exchange programs, which allow drug users to swap dirty needles for clean ones to thwart the spread of HIV and hepatitis C, as well as offering other "harm reduction" services. Most new hepatitis C cases result from drug users sharing needles.

As of June 2, Kentucky had 62 operating syringe exchanges in 55 counties, with four more approved but not yet operational.

Mike Selick, with the national Harm Reduction Coalition, pointed to other ways Kentucky leads the nation in harm reduction, including its Good Samaritan law, its standing order for a drug that is used to reverse opioid and heroin overdoses called naloxone, and its efforts to increase access to medication-assisted therapies (MAT) such as buprenorphine.

That said, he also offered examples of how Kentucky could improve its harm-reduction programs, such as increasing the days and hours that syringe exchanges operate; getting rid of any requirements that the exchanges be one-for-one; increasing access to naloxone and MAT in rural areas; and getting rid of any prior-authorization insurance requirements for MAT.

Kentucky got a "B" on the report card, "Hepatitis C: State of Medicaid Access," largely because it provides "moderate access" to treatment. The report, and several speakers at the conference, called for removal of specialist restrictions in treating hepatitis C and for managed-care organizations, which care for most Medicaid patients, to follow the Medicaid fee-for-service guidelines and not impose any restrictions for liver damage or sobriety for people seeking treatment for the first time.

Selick stressed that hepatitis treatment is safe and effective for people who inject drugs, pointing to research that shows reinfections rates in this population are low. Further, he said treating this population early in their infection becomes "treatment as prevention," because it would decrease the spread of the disease.

Jon Zibbell, senior public health scientist for RTI International, an independent, nonprofit research institute, noted that people who inject drugs present the largest population of new hepatitis infections, and that only 1 to 2 percent of them are being treated each year.

"This population needs to be treated if we are to stop incident infections and achieve hepatitis C elimination," Zibell said. "We cannot achieve hepatitis C elimination if we don't massively treat people who are . . . injecting drugs, and a lot of the pay restrictions are getting in the way of that."

The state health department has launched a statewide hepatitis C elimination project to create a comprehensive and statewide strategic plan to eliminate the disease. It met for the first time July 29.

In 2018, Kentucky was the first state to pass a law to require all pregnant women to be tested for hepatitis C. The law also requires that the information be recorded in both the mother's and the infant's records, and that the child be tested at 24 months for the disease. One in 63 Kentucky births are to mothers who test positive for hepatitis C.

Gupta told the group that subject to change after public and peer-review comment, the CDC would be changing its guidance on hepatitis C screening next year to recommend it for all pregnant women, at least once in a lifetime for all adults, and periodic testing for people with risk factors.

The Kentucky Rural Health Association has started a nationally recognized provider training program called  the Kentucky Hepatitis Academic Mentorship Program, or KHAMP, which so far has trained over 100 providers to treat hepatitis C.

Hep C treatment comes at a cost

One of the challenges to treating hepatitis C is the cost, though an argument can be made that it is more expensive to care for these patients when they progress to late-stage liver damage, liver cancer or need a liver transplant.

Dr. Bennett Cecil, medical director of Hepatitis C Treatment Centers in Louisville and Russell Springs, told the group that the cost for a treatment has dropped to upwards of $30,000, down from about $80,000 several years ago.

Kathleen Winter, as assistant professor in the division of epidemiology at the University of Kentucky College of Public Health, offered some numbers to show the scope of the problem.

Her slides showed that in 2017 Kentucky screened 70,270 people on Medicaid for hepatitis C, and 21,322 of them, or 30 percent, were diagnosed with chronic hepatitis. Only 499 were treated. In 2018, when the state loosened its treatment restrictions, Medicaid screened 79,647 people, 22,342 of them were diagnosed with a chronic infection, and 1,924 were treated.

Winter also showed cost data from the Kentucky All-Payer Hospitalization Claims database that found in 2018 there were 2,973 hospital admissions for patients who had both hepatitis C and liver disease or liver cancer, and that these patients incurred more than $181 million in patient pre-negotiated charges. Adjusted, she said, that would be upwards of $90 million a year to treat chronic, late-stage hepatitis C.

It also found 68 admissions related to liver transplants associated with hepatitis C, which had $4.8 million in associated cost. She said most of these patients were either on Medicare or Medicaid.

While most of these patients were older, Winters pointed out that the largest burden of the disease is with younger adults, who are largely in the early stages of the disease process, and who if not treated will present a tremendous cost-burden to the health-care system in years to come.

Winter also presented her research on pregnant women on Medicaid with hepatitis C, which found that many of them could not correctly identify their hepatitis C status, even though they had been tested; many did not understand how the virus was transmitted; many knew it could be treated, but didn't know what that treatment entailed; many knew treatment was important, but had widespread misunderstandings about what Medicaid would cover -- which Winter said was also a widespread problem among medical professionals.

Hepatitis A

Kentucky has made great progress in decreasing its number of new hepatitis A cases, but not without criticism for what some say was a slow response to the nation's largest outbreak of the disease.

Since August 2017, there have been 4,793 cases of hepatitis A in Kentucky, with more than half of them hospitalized (2,311) and 59 dead from it, according to a weekly surveillance report. The primary risk factors for hepatitis A are drug use and homelessness.

Andy Beshear addressed the conference.

Attorney General Andy Beshear, the second speaker of the day, was quick to criticize Gov. Matt Bevin's administration for its slow response to the hepatitis A outbreak. Beshear is running against Bevin in the Nov. 5 gubernatorial election. 

To a room full of applause, Beshear first thanked Dr. Robert Brawley, the state's former infectious-disease chief, for his "courage in doing what is right," even though it cost him his job. Brawley is a volunteer with KRHA and was a co-moderator of the event.

Beshear was referring to Brawley's request that the state have a more aggressive response to the outbreak, including $6 million to buy more vaccines and $4 million for temporary health workers to help administer them. Brawley also called for the state to declare a public-health emergency as a way to get more federal funds, the Louisville Courier Journal reported.

Health Commissioner Jeffrey Howard didn't declare an emergency but sent local health departments $2.2 million and committed to seek more funding if needed. Howard and other state officials have defended their actions, citing that logistical challenges were greater than the 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.

Beshear said, "I think when you also look at hepatitis, we see an absolute failure by the Bevin administration that cost people their lives. They had the information, they had the ability to respond in a real way for only about $10 million, but they didn't listen. Instead they had people inexperienced and incompetent in really important positions."

The health cabinet stood by its decisions, stating in an e-mail that their response to the outbreak "followed protocol and procedures guided by the CDC and informed by an entire DPH team."

"While hindsight might provide more context for some things now, in retrospect there's not a single decision that I'm aware of that has been made in real time, with the information available at the time, that I would change," Health Secretary Adam Meier said in the e-mail.

Howard, a physician, recently resigned as commissioner to pursue a fellowship in Washington, a spokeswoman from the cabinet told the Courier Journal.

Maria Hardy, the public health director at Ashland-Boyd County Health Department, painted a pretty grim picture of the financial cost associated with the outbreak. Boyd County has been one of the counties hardest hit by the outbreak, with an incident rate of 362.7 cases per 100,000 people.

Because many of the people testing positive for hepatitis A in Boyd County kept showing up in the food-service industry, at the health department's recommendation the county passed an ordinance requiring all food workers be immunized against hepatitis A.

Hardy said her health department's hepatitis A costs have been "devastating to budget." From January 2018 to June 2018, the agency spent $718,902, including the cost of salaries, vaccines and certified mailings. She added that the department got $183,520 from the state to buy more vaccine.

Looking to the future

To applause, Zibbell suggested that it was time to turn syringe-exchange programs into medical homes for people who use drugs, largely because of the stigma in traditional health-care settings against this population.

Dr. Daniel Moore, of the emergency-medicine department at UK HealthCare, said emergency departments must play a significant role in eliminating hepatitis C because they see the "downstream" effects of the disease and are the only places that most drug users interact with the health-care system.

Moore is conducting a grant-funded pilot study that allows him to screen every patient in the UK emergency department for hepatitis C. He said research shows that risk based screening would miss about 25% of people who would test positive for hepatitis c.

Between July 2018 and July 2019, he said the ED had done about 23,000 tests, with about 11% of them testing positive for ever having been exposed to hepatitis C and more than 50% of that group testing positive for an active virus. He added that 443 of these patients had been linked to care.

He said the next step toward elimination of this disease will be to bring drug treatment and hepatitis C interventions to the point of contact in the ED, just like they already do for patients who have had a stroke or a heart attack.

"This is a disease that has a cure," he said. "The patients are in front of me and there is a cure."

State's sixth annual Viral Hepatitis Conference to be held July 31

Kentucky will hold its sixth annual conference on viral hepatitis on July 31 in Lexington, three days after World Hepatitis Day.

"Hepatitis in Kentucky: The Role of Professionals in Hepatitis Elimination" will be hosted by the Kentucky Rural Health Association and run from 7:30 a.m. to 5 p.m. at the Griffin Gate Marriott Resort in Lexington.

The agenda for the event has not been released. Click here for more information and to register. Continuing education credits will be offered to medical professionals.

The association also offers the Kentucky Hepatitis Academic Mentorship Program, or KHAMP, which is an in-depth training for providers to learn how to treat and test for hepatitis C.

The next KHAMP event will be held the day after the hepatitis conference, Aug. 1. Click here to register. The program is offered throughout the year in varying locations. The following one will be held on Oct. 8 in Benton.

To date, more than 100 providers have taken the training, resulting in over 300 consultations, according to Tina McCormick, executive director of the association.

For more information about the program, contact McCormick at KRHA@twc.com or KRHA.KHAMP@gmail.com.

Hepatitis, a serious liver disease, is a real problem in Kentucky.

The state identified an outbreak of hepatitis A in November 2017. According to the state's weekly report, 4,682 Kentuckians have been diagnosed with hepatitis A and 2,262, or 48 percent, have been hospitalized. Fifty-eight people in the state have died from it. The primary risk factors for getting the highly contagious disease remains illicit drug use and homelessness.

Kentucky also leads the nation in hepatitis C, which is commonly spread by the sharing of needles among intravenous drug users.

State health department funds mobile syringe exchange for Laurel, Whitley, Knox, Clay and Jackson counties

A mobile syringe exchange will go to five Eastern Kentucky
 counties: Knox, Laurel, Whitley, Clay and Jackson. (WYMT-TV) 

Five Eastern Kentucky counties will soon have a mobile syringe exchange to minimize the spread of infectious diseases and to help get people who are addicted to drugs into treatment, Justin Kase reports for WYMT-TV in Hazard. It is expected to be running in two months.

A specially outfitted van, called a Mobile Harm Reduction Unit, is funded by a grant from the state Department for Public Health and will serve adjoining Knox, Laurel, Whitley, Clay and Jackson counties. All but Jackson are among the top 54 counties in the nation with an increased risk of outbreaks of hepatitis C and HIV due to intravenous drug use.

Mark Hensley, the executive director of the Laurel County Health Department, told Kase that the mobile exchange will offer many of the same services as stationary ones, including HIV and hepatitis C testing, hepatitis A vaccines, information about addiction treatment, and a peer counselor aboard.

Each of the counties in the program has an established syringe exchange in place. Hensley said Laurel County opened its syringe exchange about two months ago, and participation has been a bit slow. He told Kase that he expected better participation with the mobile van because it might help to break down some of the barriers associated with syringe exchange programs, such as "reliable transportation or just fear of the program itself."

The plan is for the unit to spend one day in each county before moving on to the next. Locations have not been determined. "We might establish four different locations within the county, you know, maybe try to hit the four corners of those rural areas," Hensley told Kase.

47 Ky. counties have syringe exchange programs, but only half of the 54 at higher risk of HIV and hepatitis C outbreaks have them

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in the number of syringe exchange programs, but passing such programs continues to require great amounts of public education and perseverance.

Daviess County, home of Owensboro, the state's fourth-largest city, is the latest to launch a syringe exchange. That brings the number of exchange locations to more than 50, in 47 of the state's 120 counties. Graves County has approved a program, but it's not yet operational.

Western Kentucky has been slow to adopt such programs, which were approved by the state legislature in the 2015 anti-heroin bill as part of an effort to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles by intravenous drug users.

Daviess County's program, which will serve residents of the seven counties in the Green River health district, is the fourth syringe exchange to open west of Louisville. The others are in Muhlenberg, Warren and Barren counties.

Daviess County Judge-Executive Al Mattingly said the slow embrace of exchanges in Western Kentucky is because there has been less need for the programs in that part of the state, Katie Pickens reports for The Owensboro Times, an online newspaper.

The latest Kentucky Health Issues Poll found that the percentage of adults in Western Kentucky who knew someone who used heroin was 12 percent, compared to 36 percent in Northern Kentucky, 24 percent in Lexington and Louisville and 21 percent in Eastern Kentucky.

Daviess County is not one of the 54 Kentucky counties listed by the federal Centers for Disease Control and Prevention to be most at risk to outbreaks of HIV or hepatitis C as a result of IV drug use, but it is near three counties that are on that list that haven't approved syringe exchange programs: Breckinridge, Grayson and Edmonson. None are in the Green River health district.

Of those, Grayson County has come closest to getting one. The county health board and the Leitchfield City Council have already approved it, but the county Fiscal Court failed to get a second to a motion for it on Jan. 15, Matt Lasley reports for the Grayson County News-Gazette. (The health board, fiscal court and the legislative body of the city where the exchange is to be located must approve it.) UPDATE: The fiscal court unanimously rejected the idea on Feb. 8.

The first failed vote followed two hours of testimony, both for and against the program, Lasley reports. And it seems the course of these discussions are similar across the state.

Proponents, largely from the medical community, line up to present evidence-based research about syringe exchange programs that shows how they do not encourage people to start using IV drugs,or increase the frequency of use among current users; how they reduce the spread of infections like HIV and hepatitis C; how they do not increase community crime; how they do increase community safety by taking dirty syringes off the street; and how they are known to help connect people to treatment, with one study finding that syringe-exchange participants are five times more likely to enter a drug treatment program than non-participants.

Opponents say they believe that the programs enable addiction, increase drug use or would bring drug users from neighboring counties into their communities, which could lead to more crime. Others struggle with providing an addict with a tool to feed their addiction. And many simply say they don't believe the research.

"Commonwealth's Attorney Rick Hardin said he was hesitant to believe statistics that say needle exchange programs actually increase an individual's likelihood to attend rehabilitation, as well as whether they cut down the spread of diseases such as hepatitis and HIV," Lasley reported for the Leitchfield newspaper. Hardin also prosecutes felony cases in Breckinridge and Meade counties.

Dr. Joe M. Lee

On Jan. 22, the News-Gazette published a guest editorial by Dr. Joe M. Lee, medical director of the local health department, that tried to overcome the opposition by giving the paper's readers more information. "Part of the magistrates’ concern was that the people they represent don’t understand the program and were generally opposed to it," Lee wrote. He said there had been "huge increase in Hepatitis C and HIV/AIDS" in the county, mainly as a result of intravenous drug use.

"This is a public health emergency," he wrote in bold letters."Please encourage your magistrate to vote YES and let's help our county begin recovery from this epidemic. You may be saving the life of a child, a loved one, a neighbor or a friend." Grayson County Judge-Executive Kevin Henderson said he may call up the issue again, Lasley reports.

Meanwhile, the Twin Lakes Regional Medical Center in Leitchfield will soon offer an opioid medical stabilization program for expectant mothers. CEO Wayne Meriwether said he started the program because one of the hospital's OB-GYNs said he cares for a large number of mothers who are addicted to drugs, Amy Lindsey reports for the News-Gazette.

Farther east, in the Bluegrass region, Scott County is one step closer to adopting a syringe exchange. After the fiscal court voted it down in December, with two magistrates absent, it was called back up for a vote in January and passed 5-3. The program already has the approval of the county's board of health and now must be approved by the Georgetown City Council, Paul Watson reports for the Georgetown News-Graphic. Scott County has been debating the issue for about two years.

Other localities that are actively considering a syringe exchange program are Henderson and Todd counties and Cave City in Barren County.

State Rep. Kim Moser

The chair of the House Health and Family Services Committee, Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News that she would like to see the law changed to let the local health board and health department start syringe exchange programs on their own.

"This is the only issue that the legislature gets involved with in telling the health department what to do," said Moser, who once ran the Northern Kentucky branch of the state Office of Drug Control Policy.

Needs-based vs. one-for-one syringe exchanges

Another point of contention is whether these programs should be based on the weekly injection needs of the client – called needs-based – or whether they should require a one-for-one exchange of syringes.

Health officials say that if the goal of the program is to stop the spread of infectious diseases such as HIV and hepatitis C, Kentucky must allow intravenous drug users to have as many needles as they need in order to have a clean one for every injection, and that a one-for-one requirement defeats that purpose.

A one-for-one model is also listed on the Cabinet for Health and Family Services' website as one of the "practices to avoid" because it "results in sharing of needles."

Senate Majority Floor Leader Damon Thayer, R-Georgetown, a critic of the program since its inception, has filed Senate Bill 69 that would require syringe exchanges to dispense only one clean needle for each used needle.

Sen. Damon Thayer

"I would love to get rid of the needle exchange altogether," Thayer told Lawrence Smith at WDRB, "but I don't think I could get that passed." He added, "I respect the public health argument. I just am philosophically opposed to taxpayers paying for a needle for someone to do an act that is illegal."

Moser said she doesn't support Thayer's bill and hopes it doesn't get out of the Senate Health and Welfare Committee. "I oppose it," she said. "I do not think that removing programs that are working, that are getting people into treatment is the way to go."

Moser pointed out that health departments are statutorily required to reduce communicable diseases, and that's what a syringe exchange program does. Further, she said Kentucky can't afford to pay $80,000 per hepatitis C treatment for its Medicaid patients, when a "very simple, cost effective" solution to prevent hepatitis C is a six-cent needle.

Dr. Lynne Saddler, Northern Kentucky Health Department's district director, also opposes Thayer's bill. She told Terry DeMio of the Cincinnati Enquirer, "The science is clear that a 1:1 [one-for-one syringe] policy is not effective in stopping the spread of HIV through injection drug use."

The Louisville and Fayette County programs use a needs-based model, as do some others. But many of them start off by giving out a set number of needles on an as-needed basis, and then move to a one-for-one model. Counties that use any grant money from the Kentucky Agency for Substance Abuse for their syringe exchange programs are required to use a one-for-one model.

Ky.'s hepatitis A outbreak is over 3,000 cases. It may be slacking off, but it's done that before. Advice: wash hands, get vaccinated.

Chart by WKYT-TV, based on data from Kentucky Department for Public Health, adapted by Kentucky Health News

Kentucky Health News

Kentucky's hepatitis A outbreak appears to have hit a plateau or even be slacking off, but it has made such moves before, and then resurged. And the state continues to record about 60 new cases a week. The state Department for Public Health has logged 3,122 cases from September 2017, the start of the outbreak, through the first week of December 2018.

That being said, the department's most recent weekly report showed the largest one-week drop in reported cases since the outbreak began, to levels that haven't been that low in five months. The biggest single week was in late October.

The outbreak has been blamed for the deaths of 19 Kentuckians, "and 82 percent of Kentucky's 120 counties have reported at least one case," Lexington's WKYT-TV reports. "More than half of the cases have led to patients being hospitalized. . . . Carter County has the highest incident rate per capita."

Hepatitis A is transmitted by oral contact with fecal matter, and there is no cure, so authorities urge hand washing and vaccinations. The disease attacks the liver and causes symptoms including abdominal pain, nausea, diarrhea, fever and yellowing of the skin.

Local outbreak of hepatitis A declared in Madison County, calling for vaccinations; heavy demand for vaccine in Whitley County

Madison County health officials have declared a local outbreak of hepatitis A and called on all local residents to get vaccinated for the liver disease that lives on poor hygiene.

"There are now 24 hepatitis A cases in Madison County related to the statewide outbreak that produced more than 2,050 across Kentucky," reports Mike Stunson of the Lexington Herald-Leader, citing the county health department. "It reported 13 cases on Oct. 6."

The department recommended hepatitis A vaccinations for all residents.

In Whitley County, where 99 cases have been reported, "Pharmacies are struggling to keep up with the demand for vaccines," reports Phil Pendleton of Lexington's WKYT and Hazard's WYMT.

"Rick Loudermelt at Whitley Pharmacy in Williamsburg says they have given out numerous vaccines since May of this year," Pendleton reports. "He says it's been hard to keep up with the demand, administering between 15 and 20 a week."

Madison County Public Health Director Nancy Crewe said vaccinations “should have a mitigating effect on the severity of the outbreak. We certainly don’t think there is any need for panic, but it is important that we get the word out to our citizens and encourage them to get the vaccine.”

The state Department for Public Health says more than 1,100 people have been hospitalized, and 14 died, in the statewide outbreak since November 2017.

Hepatitis A is usually spread when someone eats or drinks something contaminated by small amounts of stool from an infected person, according to the health department.

Symptoms include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine and yellowing of the skin and eyes. People can become ill 15 to 50 days after being exposed to the virus.

"Aside from the vaccination, good hand-washing is also recommended to help control the spread of hepatitis A," Stunson notes.

Lexington hepatitis A cases more than double, highlighting local health department's call for vaccination against the liver disease

The number of hepatitis A cases in Fayette County more than doubled last month, says the Lexington-Fayette County Health Department. It confirmed 13 cases in September, increasing its total in the year-long statewide outbreak ro 24.

Of the total, 13 were from drug use, four were homeless people involved with drug use, and two were people who were in contact with a homeless person affected, department spokesman Kevin Hall told Mike Stunson of the Lexington Herald-Leader.

Four of the cases had no risk factors, “so it’s important for everyone in the community to be aware of the need for the hepatitis A vaccine,” Hall said.

Last month, the health department advised all residents of the county to get vaccinated for the liver disease as the outbreak continued to spread. The vaccine is given in two doses, six months apart.

“The best way to prevent hepatitis A is to get vaccinated,” said Dr. Kraig Humbaugh, the county health commissioner. “The vaccine is effective and has an excellent track record. However, most adults have not yet been immunized, since the vaccine was not given routinely as part of their childhood schedule of shots.”

Health officials also stress the need to wash hands. The disease is “usually spread when a person unknowingly eats or drinks something contaminated by small amounts of stool from an infected person,” the health department says.

As of Sept. 22, there had been 1,851 cases of hepatitis A in Kentucky since November. "The number includes 1,029 hospitalizations and 14 deaths, according to state health department data," Stunson reports.

Hepatitis A symptoms include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and yellowing of the eyes and skin. People can become ill 15 days to 50 days after being exposed to the virus.

The Mayo Clinic and the federal Centers for Disease Control and Prevention say there is no treatment for hepatitis A, "which eventually leaves the body on its own," Stunson reports. "Some patients’ symptoms, including nausea, are treatable. Some severe cases with more problems require hospitalization. Liver failure can lead to death."

Read more here: https://www.kentucky.com/news/local/counties/fayette-county/article219480605.html#storylink=cpy

Ky. making great strides in treating patients with hepatitis C, with harm-reduction programs and fewer restrictions on treatment

By Melissa Patrick
Kentucky Health News

Eliminating hepatitis C in Kentucky and the rest of the nation will require universal screening and non-restricted access to treatment, and because new cases of the disease are largely driven by intravenous drug use, states must also commit to increasing harm-reduction programs like syringe exchanges and medication assisted therapies.

Those were the overarching messages to more than 300 people who attended the fifth annual Viral Hepatitis Conference in Lexington on July 31. The good news was that Kentucky has made great strides on all of these fronts since last year's conference, which had a similar message.

Access to harm reduction is one of the areas in which Kentucky has excelled.

Cincinnati Enquirer photo

Dr. Allen Brenzel, medical director for the Department of Behavioral Health and Developmental Disabilities, told the crowd that one of the things he was most proud of was the state's syringe exchanges, which are mainly intended to decrease the spread of infectious diseases, such as hepatitis C and HIV.

Kentucky leads the nation in the number of counties with local syringe exchanges. As of July, 45 of the state's 120 counties have approved such programs at more than 50 sites. That's a lot more than Brenzel expected under a 2015 law that requires approval by the local health board, the county fiscal court and governing body of the city where the exchange is to be located.

"I travel a lot, and the fact that Kentucky has harm-reduction syringe exchange is one of the things I'm most proud of . . . It's an incredible thing," Brenzel said. "We all thought we'd have four or five of them in our urban areas, but what I think is exciting is that our rural counties stood up and said, 'We're tired of this. We're tired of our neighbors dying; we're tired of our friends [dying]. We know this is a health risk.'"

Only about 10 percent of syringe-exchange participants agree to be tested for hepatitis, and critics of the programs claim they enable drug use. On the recent KET program "Disrupting the Opioid Epidemic," host Renee Shaw asked Jennifer Hancock, president and CEO of Volunteers of America Mid-States, about that.

"It is enabling people to take that first courageous step toward a path of recovery," Hancock replied. Earlier, she said, "They are absolutely saving people’s lives."

Hancock, Brenzel and Dr. Ardis Dee Hoven, an infectious disease specialist with the state Department of Public Health, said the exchange specialists strive to build long-term relationships with their clients, making it easier to eventually steer them toward treatment.

"This is not about a supply of needles,” Brenzel said. “This is about the first step in the road to recovery."

At the conference, Brenzel also talked about the state's many different programs that are set up to distribute naloxone, the life-saving drug that can reverse the effects of an opioid overdose. Brenzel added that the U.S. surgeon general has said that having access to naloxone and learning how to use it is "as important as learning CPR."

Jon Zibbell, senior public health scientist at RTI International, an independent nonprofit research institute, told conference attendees that the nation has both a health-care crisis and a public-health crisis.

He said that while it's important to treat the 4 million people who are chronically infected, especially because we know that between 8,000 and 10,000 of them will die annually from a liver-related illness, it is the IV drug users with hepatitis C who are creating the public health crisis.

"The only real way to address the public health crisis for hepatitis C and hepatitis B is to address the people who are still injecting, to protect those downstream transmissions," Zibbell said.

On top of treating people who are actively using drugs, he said, the best way to treat these individuals may be to create a "one-stop-shop" for related services, including hepatitis C treatment, medication-assisted therapies, syringe exchange and access to naloxone.

"We need a way to make it so infected people don't transmit the virus and uninfected people don't acquire the virus, and then naloxone to keep them alive," he said.

Kentucky no longer requires people getting hepatitis C treatment to stay off illicit drugs, only that they be screened and counseled for any illicit drug use. The state has also removed the requirement that only allowed treatment during advanced stages of the disease; now anyone can be treated for it.

The state still requires the disease be treated by or in consultation with a specialist, which is a challenge because there aren't enough specialists to meet Kentuckians' needs.

Dr. Jens Rosenau, an associate professor of medicine at the University of Kentucky and a hepatologist and gastroenterologist at the Kentucky Clinic, said that between July 2014 and December 2016, before the restrictions were removed, only 22 percent of his patients started treatment for the disease, largely because of the restrictions.

But after the majority of the state's managed-care organizations lifted the restrictions in April, allowing Medicaid to pay for treatment, he said his treatment uptake rates have doubled. "This month we actually started 150 patients on treatment," he said. "It is probably our record now."

Rosenau also noted that the UK Healthcare emergency department started doing universal screening for hepatitis C in July and that in just two weeks had identified more than 70 patients with the disease who didn't know they had it: "That is overwhelming." The disease is common, but latent, among the Baby Boom generation.

Kentucky is also the first state in the nation to pass a law that requires all pregnant women to be tested for hepatitis C, and for their babies to be tested at 24 months if the mother tested positive. One in 56 Kentucky births are to mothers who have hepatitis C.

Barbara Cave and Danielle Revert, family nurse practitioners in Louisville, said the state needs universal screening for hepatitis C.

Revert noted a study found that using the current guidelines for screening, 25 percent of people who would test positive for the disease would be missed. "If we're going to talk about eradicating this disease, I really think we're going to have to shift our screening focus more toward this universal screening idea," she said.

Cave added that the prevalence of hepatitis C is likely far greater than the 3.5 million that is normally reported because this number doesn't include any people who are institutionalized, incarcerated, hospitalized, homeless or are military veterans. She said the U.S. estimate should be closer to 5.2 million.

Corinna Dan, viral hepatitis policy adviser for the U.S. Department of Health and Human Services,  said it's challenging to get people to pay attention to a specific health issue like hepatitis, and that it simply doesn't have the kind of support that you see for many other health conditions, like HIV, which has a "huge advocacy base."

"We haven't done that yet effectively for hepatitis," she said. "We do need champions at the ground level, at the local level . . . because that's where people are served, that's where people have the need."

Fifth annual Viral Hepatitis Conference in Lexington July 31

Kentucky will hold its fifth annual viral hepatitis conference, "Kentucky's Hepatitis Epidemic: The Role of Professionals in Hepatitis Elimination" July 31 in Lexington, three days after World Hepatitis Day.

The meeting is hosted by the Kentucky Rural Health Association, the state Department for Public Health's Adult Viral Hepatitis Prevention Program and the Kentucky Immunization Program. It will run from 8 a.m. to 5 p.m. at the Griffin Gate Marriott Resort & Spa in Lexington and will offer continuing education credits for medical professionals. Space is limited; click here for more information and to register.

Kentucky leads the nation in the rate of new hepatitis C infections, with the highest rates occurring in the Appalachian region and Northern Kentucky, where injection drug use is most prevalent. Hepatitis C is often spread through the sharing of needles among intravenous drug users.

Laura Ungar of the Louisville Courier Journal reported in March that one in 56 Kentucky births in 2014-16 were to mothers with a history of hepatitis C, and that those births more than quadrupled between 2010 and 2016, from 260 to 1,057. The national rate in 2015 was one in 308.  Hepatitis C can be transmitted from mother to baby during childbirth. Kentucky passed a law this year that requires all pregnant women to be tested for the disease, with the results added to the child's records. It also recommends that the child be tested at 24 months if the mother tests positive.

Kentucky is also experiencing an outbreak of hepatitis A, reported by the state health commissioner as "the worst on record across the nation and in Kentucky." As of June 30, Kentucky has had 1,034  cases of hepatitis A since the outbreak began almost one year ago in August, 603 hospitalizations and seven deaths. Most of Kentucky's cases have been among the homeless and drug users.

Topics for the conference will include the national hepatitis action plan; hepatitis infections related to the growing opioid epidemic; Kentucky's opioid response efforts; best practices for screening, diagnosing and linking patients to care; innovative interventions to address hepatitis outbreaks; perinatal transmission of hepatitis; Medicaid and hepatitis treatment in Kentucky; and a session on mobilizing community action. The draft agenda and a biography of each speaker can be found on the registration website.

Perseverance is often needed to set up syringe exchanges, since local politicians have the say-so, and it's a local election year

It took two years, but Campbell and Kenton counties will finally launch their syringe exchange programs the week of July 23.

The new mobile exchanges will be run by the Northern Kentucky Health Department at locations of St. Elizabeth Healthcare. The Newport location will begin July 24 and the Covington location will start July 26, reports The River City News.

It took perseverance for the counties to establish the exchanges, overcoming social and political obstacles, like many other Kentucky counties that are still trying to create their own exchanges.

Campbell County approved an exchange in 2016, but state law requires approval from the city in which the exchange will operate, as well as the board of health and the county government, and Newport did not approve the exchange until February of this year.

Newport's decision came after a cluster of HIV cases were identified in the region, as well as a high number of hepatitis C cases. From Jan. 1, 2017, to March 16 of this year, the NKHD had diagnosed 45 cases of HIV, 21 of them intravenous drug users. From 2009 to 2016, zero to five such cases were reported each year, department spokeswoman Emily Gresham-Wherle told Terry DeMio of the Cincinnati Enquirer. The region also has a high rate of hepatitis C infections, typically carried by sharing of needles.

Kenton County and Covington had also approved a syringe exchange in 2016, but with a requirement that it could not start until two other Northern Kentucky counties in the NKHD district had operational exchanges. Campbell County's exchange allows the Kenton County program to go forward; NKHD has operated one in Grant County for three years.

The new mobile units will provide clean needles, Naloxone overdose-reversal kits, offer HIV tests, and provide referrals for other health services, including addiction treatment. What they won't do is provide condoms -- which are also known to fight infectious diseases and commonly distributed in these programs -- because the mobile exchanges will be located on the grounds of Catholic hospitals, DeMio reports.

Nevertheless, it appears that health officials in the area are grateful to St. Elizabeth for providing a site for the exchanges. Hospital spokesman Guy Karrick told DeMio that while the hospital couldn't countenance the distribution of contraceptives, it wanted to get the exchange going as quickly as possible. He added that the exchange might be better situated on health department property.

Despite the many challenges that face largely rural, conservative Kentucky counties to support opening these programs, Kentucky leads the nation in the number of counties with local syringe exchange programs (perhaps in part because it ranks third in the number of counties). As of June, 47 45 of Kentucky's 120 counties have approved syringe-exchange programs at more than 50 sites.

However, the federal Centers for Disease Control and Prevention says 54 Kentucky counties are among 220 in the nation with the highest risk of an HIV or hepatitis C outbreak among IV drug users, and half of those 54 counties still haven't approved exchanges.

One of the 27 high-risk holdouts, Clinton County, narrowly approved an exchange in March but backed out eight days later after complaints that it would encourage drug use. In the Republican primary election in May, the Fiscal Court magistrate most vocally opposed to the exchange defeated the county judge-executive, who favored it. The CDC says the county has the 11th greatest risk of any county in the nation for an HIV or hep-C outbreak among drug users.

Lawrence County, ranked 39th on the list, has also struggled with the issue. The county health board approved the proposal in September 2016, and the Louisa City Council followed suit in July 2017, the Fiscal Court unanimously rejected the proposal in March, WYMT-TV reported.

County Judge-Executive John Osborne told a packed house at the meeting that while he worries about HIV and hepatitis C, he worries about needles more, WYMT reported. "If you give out 40 needles at a time, you're probably are going to see a lot more needles on the ground," Osborne said. “It does bring a lot of people not from this area and that could cause a lot more problems.”

Public Health Director Debbie Miller told WYMT that she was disappointed but not surprised with the result. “I feel like the Fiscal Court is telling us that they’re not concerned with the fact that Lawrence County has been deemed one of the most vulnerable counties in the U.S. for an HIV or hepatitis C outbreak," she said. "The bottom line is, no matter how uncomfortable these syringe exchange programs make us all feel, and they do all make us somewhat uncomfortable, they are proven to save lives."

On the other hand, five Eastern Kentucky counties on the CDC list have started syringe exchanges in the last few months.

Perry, Letcher and Wolfe counties added exchanges in April "thanks to the expanded initiative by the Kentucky River District Heath Department," Will Puckett reported for WYMT in April. That came a few months after after Lee and Owsley counties approved theirs.

Scott Lockard, the department's public health director, told Puckett that the price of bringing in used needles and exchanging them for clean ones is small compared to the cost of treating diseases: $80,000 for a case of hepatitis C, "and the cost for someone who contracts HIV can cost over half a million dollars."

Getting county officials to accept a syringe exchange program often depends on public education and perseverance, as evidence by another county that took two and one half years to get its exchange.

In March, Mary Meehan reported for Ohio Valley ReSource that it took Bourbon County two and a half years, and two failed votes, to get an exchange. It finally passed on a 6-2 Fiscal Court vote, and opened its doors in May.

Bourbon County is not on the CDC list, but the concerns there reflect those voiced across the state. People worry that the drug users will just take the needles and sell them; some say drug users are just looking for a handout; others say it is enabling their misbehavior, and others worry that it will draw addicts from surrounding counties that don't have exchanges.

Research shows that syringe-exchange programs do not encourage the initiation of drug use, nor do they increase crime or the frequency of drug use among current users. They do reduce the spread of infectious diseases like HIV and hepatitis C; increase community safety; and connect people to treatment, according to the state Cabinet for Health and Family Services.

Meehan writes, "The health facts run up against deeply help opinions about the moral aspects of drug use and the notion that a needle exchange enables drug addicts to continue harmful behavior." She reported that Bourbon County Judge-Executive Mike Williams encouraged other community leaders to persevere. "It took us three times," he said. "Don't give up, and keep presenting the facts."

The State Journal in Frankfort recently said in an editorial that syringe exchanges are part of a holistic approach to fight the opioid epidemic, noting that the Franklin County's exchange had provided more than 115,000 clean syringes to users, and collected more than 82,000 used ones.

The newspaper said there are still many in Franklin County who object to the exchange, but "We’d ask whether it’s better for a user to share needles and potentially infect others or be infected or to use clean needles and reduce or eliminate the chance of infection."

Hepatitis A outbreak worst ever; Ky. leads the nation; state health commissioner advises Kentuckians to wash hands, get vaccinated

Image: WNDU

State health officials say the hepatitis A outbreak in Kentucky is the worst ever, and the crisis isn't over.

"It's the worst on record across the nation and in Kentucky," Dr. Jeff Howard, Kentucky Commissioner of Public Health, told Beth Warren of the Louisville Courier Journal.

Kentucky health officials have confirmed 969 cases and six deaths from the highly contagious liver disease. No other state has reported as many.

Warren notes that Louisville has been the hardest hit, with 480 cases and three deaths. The other deaths were in Ballard, Meade and Greenup counties. Kentucky normally only has about 20 hepatitis A cases a year.

The state Department for Public Health reports that most of the cases have been among the homeless and drug users. So far, there haven't been any food-related transfers of hepatitis A, but it's a major fear.

"Sharing a home, a cigarette, marijuana joint, a drink, or sex with someone who has the virus puts you at high risk," according to an advisory website in Louisville, Warren notes.

The health department's weekly hepatitis A outbreak report, which was last updated on June 16, shows that Bell, Breathitt, Butler, Edmonson, Johnson and Washington counties have identified their first cases since August of last year.

Health officials urge people who live in counties with an outbreak, and those who are in high-risk groups, to get vaccinated against hepatitis A. They also encourage people who work in food preparation and service to get immunized. Immunization requires two vaccines, six months apart.

Public schools across Kentucky require students to get the vaccine before starting school this year.

Besides Jefferson County, the 11 other counties reporting five or more cases are: Ballard, Grayson, Ohio, Rowan, Shelby, Whitley, Fayette, Powell, Lincoln, Grant and Bourbon.

Officials are also encouraging everyone to wash their hands for about 20 seconds with soap and water after using the bathroom, before they eat, and when they get home from being out in public, adding that hand gels are not an alternative because they don't kill the virus.

Warren tells the story of a Louisville woman who is one of the 10 percent of people in Louisville who got the virus but was not in a high-risk group.

Angela Glotzbach, a medical sales representative, told Warren that she was "baffled" by her diagnosis and described being sick for three months as "1,000 times worse than the flu."

"Dehydration from vomiting and diarrhea sent her to the hospital three times and she suffered tremors, joint and back pain, fatigue and trouble forming sentences," Warren writes.

The most common symptoms of hepatitis A are fatigue, low-grade fever, loss of appetite, joint pain, sudden nausea and vomiting, yellow eyes or skin, abdominal pain, pale stools and dark urine. A person with the virus is contagious for up to two weeks before showing symptoms and one week after. Symptoms usually last less than two months, but 10 percent to 15 percent of victims remain sick for up to six months.

Dr. Paul Schulz, infectious diseases specialist and system epidemiologist for Norton Healthcare, told Warren that it's unlikely that most adults got the vaccine as a child unless they traveled abroad or were in a high-risk population because it wasn't available until 1995, and wasn't added to the child immunization schedule until 1999. He added that a health care provider can perform a simple blood test to see if someone has been vaccinated or has immunity.

Hepatitis A keeps spreading; 'Wash your hands,' editor says

https://www.state-journal.com/2018/06/18/editorial-amid-outbreak-listen-to-health-professionals/

State urges hepatitis shots for everyone in 10 counties with outbreaks; also: keep hands washed, but not with gels

Acting Health Commissioner Dr. Jeffrey Howard (left) and
Cabinet for Health and Family Services spokesman Doug Hogan
talked about the hepatitis A outbreak in a Facebook Live event.

By Melissa Patrick
Kentucky Health News

As the number of hepatitis A cases continues to rise in Kentucky -- up to 629 this week -- and the number of counties with an outbreak has increased by four, the state's top health official encouraged Kentuckians to be aware and take precautions against the highly contagious liver disease -- but to keep calm.

"I don't think there is a necessity to panic, but people do need to be aware that there is an outbreak going on in the state and take appropriate precautions," Dr. Jeffrey Howard, acting commissioner of the Department for Public Health, said during a May 24 Facebook Live event.

Howard offered these suggestions to protect yourself from the disease, which is typically caused by ingesting food or drink that is contaminated with fecal matter: avoid hand-to-mouth contact, get vaccinated and wash your hands with soap and water.

"The most important thing that someone can do in the state of Kentucky right now is wash your hands appropriately," Howard said, which he said means washing your hands with soap and water for at least 20 seconds and then drying them off.

He added, "Hand gels are not an alternative. They do not kill hepatitis A."

Howard also advised anyone living in Boyd, Bullitt, Carter, Greenup, Hardin, Jefferson, McCracken, Meade, Montgomery and Warren counties, where outbreaks have been identified, to get vaccinated. Immunization requires two vaccines, six months apart.

McCracken, Meade, Montgomery and Warren counties are new to the list this week. Each of these counties have had four or more cases reported, according to the health department.

Howard announced that the department will provide each of the local departments in the 10 counties with money to buy an additional 1,000 doses of the vaccine, a total of 10,000 doses.

He urged vaccination for anyone at high risk for getting the disease: people who use illegal drugs, are homeless or have unstable housing; men who have sex with men; people recently in jail or prison; and people with underlying liver disease.

Howard also advised anyone who works with any of these high-risk populations to get vaccinated, including health care workers, church or ministry workers and volunteers.

To the concerns of some about whether they should eat out or not, Howard said, "We've had zero cases related to a food worker," and the virus in this outbreak is spreading "via contaminated environments," at least for now. The department's website says the increase in cases have primarily been among the homeless and drug users.

Howard added that Kentucky hasn't singled out food workers to get vaccinated, as West Virginia has, because the state's recommendation is for everyone in an outbreak area get vaccinated, which includes food workers.

He encouraged people with insurance to go to their health-care provider or a local pharmacist to get vaccinated, and for those without insurance or in one of the high-risk categories to go to their local health department.

The most common symptoms of hepatitis A are fatigue, low-grade fever, loss of appetite, joint pain, sudden nausea and vomiting, yellow eyes or skin, abdominal pain, pale stools and dark urine. A person with the virus is contagious for up to two weeks before showing symptoms and one week after. Symptoms usually last less than two months, but 10 percent to 15 percent of victims remain sick for up to six months.

Howard noted that hepatitis A is "a very rare disease," and that the state normally only has about 20 cases a year. He added that the U.S. Centers for Disease Control and Prevention is working to figure out why this outbreak is occurring across the country.