Kentucky Department for Public Health KY17-089 - Acute ... · One of the deaths being reported this week was identified through periodic death record review. Weekly death counts may

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Brief Description of Outbreak: In November 2017, the Kentucky Department for Public Health (DPH) identified an outbreak of acute hepatitis A. The increase in cases observed in Kentucky was well over the 10-year average of reported hepatitis A cases, and several cases have been infected with hepatitis A virus (HAV) strains genetically linked to outbreaks in California, Utah, and Michigan. Similar to hepatitis A outbreaks in other states, the primary risk factors have been illicit drug use and homelessness. A contaminated food source has not been identified, and HAV transmission is believed to have occurred through person-to-person contact. Below is a weekly and cumulative update on the outbreak. Please note that all data is preliminary and subject to change as additional reports are received. In accordance with 902 KAR 2:020, cases of acute hepatitis A should be reported within 24 hours. The case definition used for outbreak-associated acute hepatitis A cases is available upon request. Unless otherwise noted, all data are reported by date of specimen collection.

Table 1: Summary of Outbreak-Associated Acute Hepatitis A Cases*

* Cases are reported based on date of specimen collection.

Cases are generally confirmed weeks after submission for testing, so will only be reflected in total case counts.

† Deaths are defined as any outbreak-associated acute hepatitis A case with documentation of hepatitis A as a contributing

factor to the individual’s death. #

One of the deaths being reported this week was identified through periodic death record review. Weekly death counts may

appear artificially high due to delays in death certification.

Update for Week 44: Total Case Counts: 8/1/2017 – 11/2/2019:

Number of new cases (n=2):

Confirmed - 0

Probable - 1

Suspected - 1

Total number of cases (n=4966):

Confirmed - 841

Probable - 2763

Suspected - 1362

Number of counties with new cases:

2

Total number of counties with cases:

114 (95% of KY counties)

Number of individuals with specimens

submitted for genotyping where results are available:

0

Number of individuals with specimens submitted for genotyping where results

are available:

885 (18%)

Number of cases with genotype IB among those with genotype

testing:

0

Total number of cases with

genotype IB among those with genotype testing:

824 (93% of those tested)

Number of

Hospitalizations: 1

Total Number of

Hospitalizations: 2395 (48%)

Number of deaths

Reported†: 0

Total number of deaths

reported†: 61 (1.2%)

Kentucky Department for Public Health KY17-089 - Acute Hepatitis A Outbreak Weekly Report

Morbidity and Mortality Weekly Report (MMWR) Week 44, 2019 October 27, 2019 – November 2, 2019

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Table 2: Cumulative Distribution of Cases by County

KY17-089 Distribution Of Outbreak-Associated Acute Hepatitis A Cases,

by County, August 1, 2017 – November 2, 2019*^#

County Total number of

cases reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Adair 5 0 3 2 25.7

Allen 46 8 28 10 219.7

Anderson 25 0 18 7 110.9

Ballard 12 4 5 3 149.3

Barren 16 1 15 0 36.5

Bath 37 3 13 21 298.9

Bell 70 18 31 21 260.3

Boone 65 8 34 23 49.7

Bourbon 13 0 10 3 64.9

Boyd 176 104 44 28 366.8

Boyle 31 0 18 13 103.6

Bracken 6 0 4 2 72.6

Breathitt 30 1 22 7 231.7

Bullitt 64 32 23 9 79.8

Butler 11 2 5 4 85.7

Calloway 1 0 0 1 2.6

Campbell 69 3 56 10 74.6

Carlisle 1 0 1 0 20.6

Carroll 13 2 7 4 121.3

Carter 127 46 60 21 467.9

Casey 14 1 9 4 88.9

Christian 81 27 47 7 115.0

Clark 93 0 57 36 258.0

Clay 82 1 37 44 402.6

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cases reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Clinton 15 2 11 2 146.0

Crittenden 3 0 1 2 33.0

Cumberland 4 0 4 0 59.6

Daviess 4 0 2 2 4.0

Edmonson 1 0 1 0 8.2

Elliott 24 4 4 16 319.0

Estill 26 1 20 5 182.1

Fayette 205 5 149 51 63.7

Fleming 4 0 0 4 27.7

Floyd 146 5 78 63 402.5

Franklin 58 1 43 14 114.9

Gallatin 9 3 4 2 102.6

Garrard 20 0 13 7 114.1

Grant 43 3 34 6 172.1

Graves 1 0 0 1 2.7

Grayson 30 2 25 3 113.8

Green 3 0 3 0 27.1

Greenup 62 31 19 12 174.6

Hardin 42 10 10 22 38.9

Harlan 43 17 16 10 161.0

Harrison 28 0 17 11 149.1

Hart 2 0 2 0 10.7

Henderson 1 1 0 0 2.2

Henry 13 3 8 2 81.2

Hickman 1 0 0 1 22.1

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cases reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Hopkins 66 32 19 15 144.9

Jackson 22 1 11 10 163.8

Jefferson 661 312 235 114 85.7

Jessamine 62 0 40 22 116.2

Johnson 81 1 45 35 358.5

Kenton 124 14 90 20 75.0

Knott 38 2 24 12 248.5

Knox 108 7 66 35 345.9

Larue 3 0 1 2 21.1

Laurel 224 5 164 55 372.3

Lawrence 35 4 20 11 222.7

Lee 37 3 32 2 563.2

Leslie 38 1 32 5 367.7

Letcher 22 5 14 3 98.5

Lewis 26 0 15 11 194.9

Lincoln 39 2 24 13 159.5

Livingston 2 0 0 2 21.6

Logan 2 0 2 0 7.4

Madison 148 3 99 46 162.2

Magoffin 54 1 32 21 430.7

Marion 23 1 17 5 118.6

Marshall 3 0 1 2 9.6

Martin 41 0 29 12 358.0

Mason 26 0 17 9 151.4

McCracken 15 4 6 5 22.9

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cases reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

McCreary 31 1 20 10 177.5

Meade 12 1 1 10 42.6

Menifee 18 1 11 6 278.9

Mercer 41 1 25 15 190.5

Metcalfe 2 0 1 1 19.8

Monroe 2 1 0 1 18.8

Montgomery 94 9 62 23 336.6

Morgan 23 1 18 4 174.4

Muhlenberg 5 2 1 2 16.2

Nelson 19 4 6 9 41.6

Nicholas 2 0 0 2 28.1

Ohio 7 0 4 3 28.9

Oldham 18 4 9 5 27.1

Owen 13 0 11 2 120.8

Owsley 12 0 9 3 270.6

Pendleton 30 3 19 8 205.9

Perry 89 3 63 23 335.2

Pike 85 3 60 22 144.4

Powell 51 2 30 19 412.2

Pulaski 96 0 62 34 149.0

Robertson 1 0 1 0 46.9

Rockcastle 26 0 16 10 155.7

Rowan 49 5 28 16 199.9

Russell 3 0 2 1 16.9

Scott 32 0 20 12 58.3

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cases reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Shelby 27 10 14 3 56.9

Simpson 10 3 6 1 55.2

Spencer 8 3 4 1 43.2

Taylor 50 2 35 13 196.3

Todd 1 1 0 0 8.2

Trigg 4 2 2 0 27.7

Trimble 3 2 0 1 35.0

Union 3 0 2 1 20.5

Warren 44 10 25 9 34.1

Washington 9 0 6 3 74.2

Wayne 23 1 11 11 111.0

Webster 6 4 2 0 46.1

Whitley 201 15 103 83 555.0

Wolfe 26 0 18 8 357.9

Woodford 14 0 10 4 53.1

Total Number of Cases: 4966 841 2763 1362 111.5

* Cases are reported based on date of specimen collection.

Denotes a county where cases have not been previously identified.

# As genotyping results become available, cases may be excluded if they do not meet the outbreak case definition. Cases in the following counties have been excluded from the outbreak case count this week: None.

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Figure 1: Hepatitis A Vaccine Doses Administered, Public Health Versus All Other Providers, as Reported to the Kentucky

Immunization Registry

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5000

10000

15000

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25000

30000

35000

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KY17-089 Adult Hepatitis A Vaccine Administered by Local Health Department Versus All Other Providers as Reported to KYIR, November 1, 2017 - November 2, 2019

Local Health Dept All Other Providers

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Figure 2: Geographic Distribution of Outbreak-Associated Cases by County

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Figure 3: Incidence of Outbreak-Associated Cases by County

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Figure 4: Incidence and Distribution of Outbreak-Associated Cases in the Last 30 Days, by County

*Case count for the last 30 days is displayed beside county name. Statewide outbreak-associated case count over the last 30 days is 15.

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Figure 5: Outbreak-Associated Cases by Age

*The mean age of cases is 37.6 years, and the median age is 36.0 years.

Table 3: Frequent Risk Factors of Outbreak-associated Cases

KY17-089 Risk Factors of Outbreak-Associated Acute

Hepatitis A Cases, August 1, 2017 – November 2, 2019#^

Risk Factor

Number of Cases

Reporting Risk Factor

(n=3987)*

Homelessness + No/Unk Illicit Drug Use 57 (1.4%)

Illicit Drug Use + No/Unk Homelessness 2865 (72%)

Homelessness + Illicit drug use 305 (7.6%)

No Outbreak-Related Risk Factors 760 (19%)

* Risk factor information is unavailable for 979 (19.7%) of all outbreak-associated cases. #

The percentages in the table may add up to greater than 100 percent due to rounding.

^ 38 MSM cases have been reported. Of those, 12 have reported no other risk factors. MSM is not considered an

outbreak-related risk factor.

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Age Range (years)*

KY17-089 Outbreak-Associated Cases of Acute Hepatitis A in Kentucky, by Age, August 1, 2017 - November 2, 2019

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Figure 6: Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases, by Week of Specimen Collection

1 1 1 1 2 2 4 2 3 5 3 5 5 4 5 5 6 44

8

3

128

109

22

24

18

29

29

53

43

47

59

57

46

69

57

54

83

67

68

66

78

60

64

58

58

68

8972

78

79

85

80

91

105

114

114

110

120

153

112

123

109

130

93

131

97

112109

108

79

95

83 95

62

61

46

45

53

41

41

40

41

25

22

27

23

15

24

11

23

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5

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Jul 29

- A

ug 0

5 (31)

Aug 1

3 - A

ug 1

9 (

33)

Aug 2

7 - S

ep 0

2 (

35)

Sep 1

0 - S

ep 1

6 (

37)

Sep 2

4 - S

ep 3

0 (

39)

Oct 08

- O

ct 1

4 (

41)

Oct 22

- O

ct 2

8 (

43)

Nov

05 - N

ov

11 (

45)

Nov

19 - N

ov

25 (

47)

Dec

03 - D

ec

09 (

49)

Dec

17 - D

ec

23 (

51)

Dec

31 - J

an

06 (

01)

Jan 1

4 -

Jan 2

0 (03)

Jan 2

8 -

Feb 0

3 (05)

Feb

11 -

Feb 1

7 (07)

Feb

25 -

Mar 3 (09)

Mar 11 -

Mar 17 (11)

Mar 25 -

Mar 31 (13)

Apr

08

- A

pr 14 (

15)

Apr

22

- A

pr 28 (

17)

May

06 -

May 1

2 (1

9)

May

20 -

May 2

6 (2

1)

Jun 0

3 -

Jun 0

9 (23)

Jun 1

7 -

June 2

3 (2

5)

Jul 01

- Ju

l 07

(27)

Jul 15

- Ju

l 21

(29)

Jul 29

- A

ug 0

4 (31)

Aug 1

2 - A

ug 1

8 (

33)

Aug 2

6 - S

ep 0

1 (

35)

Sep 0

9 - S

ep 1

5 (

37)

Sep 2

3 - S

ep 2

9 (

39)

Oct 07

- O

ct 1

3 (

41)

Oct 21

- O

ct 2

7 (

43)

Nov

04 - N

ov

10 (

45)

Nov

18 - N

ov

24 (

47)

Dec

02 - D

ec

08 (

49)

Dec

16 - D

ec

22 (

51)

Dec

30 - J

an

05 (

01)

Jan 1

3 -

Jan 1

9 (03)

Jan 2

7 -

Feb 0

2 (05)

Feb

10 -

Feb 1

6 (07)

Feb

24 -

Mar 02 (09)

Mar 10 -

Mar 16 (11)

Mar 24 -

Mar 30 (13)

Apr

07

- A

pr 13 (

15)

Apr

21

- A

pr 27 (

17)

May

05 -

May 1

1 (1

9)

May

19 -

May 2

5 (2

1)

Jun 0

2 -

Jun 0

8 (23)

Jun 1

6 -

Jun 2

2 (25)

Jun 3

0 -

Jul 0

6 (

27)

Jul 14

- Ju

l 20

(29)

Jul 28

- A

ug 0

3 (31)

Aug 1

1 - A

ug 1

7 (

33)

Aug 2

5 - A

ug 3

1 (

35)

Sep 0

8 - S

ep 1

4 (

37)

Sep 2

2 - S

ep 2

8 (

39)

Oct 06

- O

ct 1

2 (

41)

Oct 20

- O

ct 2

6 (

43)

Nov

03 - N

ov

09 (

45)

Nov

17 - N

ov

23 (

47)

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mb

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MMWR Week

KY17-089 Epi-Curve of Outbreak-Associated Cases by MMWR Week, August 1, 2017 - November 2, 2019

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Figure 7*: Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases, by Month of Specimen Collection

*Note: As of the report ending July 6, 2019, this figure will be based on date of specimen collection rather than date of onset to b e consistent with other figures.

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Feb

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Nov

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Feb

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KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Specimen Collection, August 1, 2017 -November 2, 2019 (Current month shown in gold - case counts are not complete)

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Figure 8: Case Count Comparison of Acute Hepatitis A cases, Jefferson County versus Non-Jefferson Counties

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Ju

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(31)

Au

g 2

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p 1

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(37)

Oct 0

1 - O

ct 0

7 (4

0)

Oct 2

2 - O

ct 2

8 (4

3)

Nov 1

2 - N

ov 1

8 (4

6)

Dec 0

3 - D

ec 0

9 (4

9)

Dec 2

4 - D

ec 3

0 (5

2)

Ja

n 1

4 - J

an

20

(03)

Fe

b 0

4 - F

eb

10 (0

6)

Fe

b 2

5 - M

ar 3

(09)

Ma

r 18 - M

ar 2

4 (1

2)

Ap

r 08 - A

pr 1

4 (1

5)

Ap

r 29 - M

ay 0

5 (1

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Ma

y 2

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ay 2

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(24)

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- Jul 0

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- Jul 2

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(33)

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(36)

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(39)

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4 - O

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(02)

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Ma

r 10 - M

ar 1

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r 31 - A

pr 0

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Ap

r 21 - A

pr 2

7 (1

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y 1

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ay 1

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0)

Ju

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2 - J

un

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(23)

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(26)

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l 14

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0 (2

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g 0

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(32)

Au

g 2

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(35)

Se

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(38)

Oct 0

6 -O

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2 (4

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Nov 1

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MMWR Week

KY17-089 Outbreak-Associated Acute Hepatitis A Cases, by Date of Specimen Collection, August 1, 2017 to November 2, 2019

Jefferson

Non-Jefferson

Documents

Kentucky Department for Public Health KY17-089 - Acute ... · One of the deaths being reported this week was identified through periodic death record review. Weekly death counts may