Hepatitis A Alert for Providers

The Chattanooga Hamilton County Health Department issued this alert to healthcare providers regarding the recent outbreak of Hepatitis A in the Hamilton County area.

August 24, 2018

Dear Medical Provider:

Currently, Chattanooga-Hamilton County is experiencing an outbreak of Hepatitis A. Typically, about one case a year is reported locally, yet since early May 2018, sixteen (16) cases have been reported. In Tennessee, over 50% of the Hepatitis A cases have been hospitalized. The Chattanooga-Hamilton County Health Department is taking action to prevent the spread of the disease. We ask that all healthcare providers take the following important steps now.

For Prevention- Please spread the word!

  1. The Hepatitis A vaccine has been required for children entering kindergarten since 2011, but most adults have not been vaccinated.
  2. Although anyone can get the disease, people most at risk for Hepatitis A infection in this multi-state outbreak include:
    • those experiencing homelessness or unstable housing
    • people who use drugs recreationally 
    • men who have sex with men

3. Please provide vaccine or refer anyone with these risk factors to the Health Department for free Hepatitis A vaccine. The vaccine is free and available Monday-Friday, 8AM-4PM. No appointment is necessary. Clinic locations are:

  • Main Campus, 921 East 3rd St., Chattanooga TN, 37403, 423-209-8340 
  • Birchwood Health Center, 5625 Hwy 60, Birchwood TN, 37308, 423-961-0446
  • Homeless Health Care Center, 730 E 11th St., Chattanooga TN 37403, 423- 265-5708
  • Ooltewah Health Center, 5520 High St., Ooltewah TN, 37363, 423-238-4269
  • Sequoyah Health Center, 9527 West Ridge Trail Rd, Soddy Daisy TN, 37379, 423-842-3031

4. In addition, the Health Department has flyers, brochures and posters that we can provide free of charge to you.

For People Who Have Symptoms

Recognize and report cases of acute Hepatitis to the Health Department. People with the acute onset of Hepatitis symptoms and no alternative diagnosis should have serologic testing for acute viral Hepatitis, including Hepatitis A lgM.

  1. For people suspected of acute Hepatitis A, collect and hold at your lab an extra red top tube of blood that may be submitted to the Tennessee Department of Health's Laboratory for confirmation and possible genotype testing at CDC if the initial Hepatitis A lgM result is positive.
  2. When taking the history of someone with suspected acute hepatitis A, please specify the date of onset of acute illness and collect key risk factors (drug use, sexual behavior, contact with other cases, homelessness, travel history) during the time they could have been exposed (15-50 days before illness) and the time they could have infected others (2 weeks before through 1 week after onset). This information is vital to public health in the event that the case patient cannot be located for a full investigation after confirmation.
  3. Do not test people without signs of acute Hepatitis. False positive lgM results can occur in persons without acute clinical hepatitis illness, especially in the elderly.
  4. Acute Hepatitis A is reportable to the Health Department at 423-209-8190.

Hepatitis A is a vaccine-preventable contagious liver disease caused by the Hepatitis A virus.

  1. Symptoms include fever, fatigue, nausea, loss of appetite, vomiting, abdominal pain, dark colored urine, clay-colored stools, joint pain, or jaundice (yellowing of the skin and eyes). It can range from a mild illness lasting a few weeks to a severe illness requiring hospitalization. It can result in lost time from school or work. Hepatitis A can cause death in some people.
  2. Hepatitis A 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. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.
  3. The best way to prevent hepatitis A is through vaccination. Other preventive measures include thorough hand washing before preparing or eating food and after changing diapers or going to the bathroom.
  4. Post-exposure prophylaxis with vaccine or immune globulin can protect at-risk contacts if administered within 14 days of their exposure.

For more information, call the Health Department's Epidemiology Department: 423-209-8190, or visit https:l/.www.cdc.gov/hepatitis/hav/

Sincerely,
Valerie A. Boaz, MD
Health Officer
Chattanooga Hamilton County Health Department