SALT LAKE CITY — An outbreak of hepatitis A has been proliferating in Utah this fall, leading Utah public health officials to warn of increased risk to all residents, not just for high-risk populations such as the homeless or drug users.
"We'd love (people) to know — yes, we're dealing with a hepatitis A outbreak," Dr. Dagmar Vitek, medical director of the Salt Lake County Department of Health, said Tuesday.
Since May, 87 hepatitis A cases that can be traced to an outbreak have been reported in Utah, according Utah Department of Health epidemiologist Jeff Eason. That's compared to only a small handful of outbreak-related cases most years, including an average of four in Salt Lake County, the epicenter of the current problem.
"We … found the first case in early May and knew it was associated with the national outbreak at the time," Eason said.
He was referring to the San Diego area, where nearly 650 infections have caused 21 deaths in 2017 as of earlier this month. The same strain of the virus found in San Diego was discovered in the Utah outbreak cases, health officials explained in September.
In the Detroit area, a hepatitis A outbreak has also led to more than 500 infections and resulted in 20 deaths, according to the Centers for Disease Control and Prevention.
No deaths have resulted from the outbreak in Utah, but 60 percent of the people affected have been hospitalized, Eason said.
"That's quite a bit higher than we would expect in a typical outbreak," he said, noting a significant number of those who come down with an infection also have additional underlying health issues.
Salt Lake County, with 66 outbreak cases, hasn't seen such diagnoses reach double digits since the late 1990s, said county health department spokesman Nicholas Rupp. There have also been 14 cases in Utah County.
A two-shot hepatitis A vaccine is shown to be more than 99 percent effective in preventing the disease for 20 to 25 years, according to Rupp. The hepatitis A vaccine has been required for all students entering kindergarten since 2002, he said, but for people who entered school before then, "that vaccine was not required at any point in their lives, most likely."
More than 7,000 vaccine kits have been distributed to public health workers in a push to curb the outbreak, Eason said.
In Salt Lake County, those workers have administered vaccinations in places with high concentrations of homeless people and recreational drug users, including Pioneer Park, the county jail, homeless shelters, various places along the Jordan River, drug treatment centers and syringe exchange locations, Vitek said.
"We're actually going to them," she said. "We really sort of have to have a completely different approach."
People most at risk of contracting hepatitis A are either homeless, actively using drugs or incarcerated, and that's what the cases reported so far have reflected, according to Vitek.
But she added the county is trying to inform all people that those groups disproportionately "are using public areas" and that "there's some overlap between these groups and the general population," meaning there increasingly is risk for people outside those circles.
For that reason, the Salt Lake County Health Department said Tuesday it is launching a new information campaign to warn people of the dangers of infection and encourage them to take preventive steps. The new campaign includes a social media awareness push and educational online videos. Utahns seeking more details about the outbreak are being directed to health.utah.gov/hepatitisa.
"(The campaign) is to make certain the public understands they need to be washing their hands," Rupp said. "This is a stark reminder of that."
Hepatitis A, an inflammation of the liver that carries the risk of numerous serious symptoms, can be spread through even tiny amounts of feces from an infected person, which means it is frequently spread through contaminated food or drink. It can also spread through sexual contact.
A person is more susceptible to infection it they don't wash their hands after using the restroom, before eating or before preparing food, Vitek said. She stressed that people are in control of mitigating their own risk.
"You can protect yourself by washing your hands and getting the vaccine," she said.
The county has been in touch with restaurants and other food providers in recent months in an effort to educate them about ways to be especially vigilant in fighting the virus, Rupp said. One example is that food preparers are being asked to use bleach instead of ammonia, since the latter is not as effective specifically against hepatitis A.
Eason said it is difficult to know whether the outbreak has peaked, thanks to "what we call a long incubation period." It can take from two to six weeks for the virus to fully manifest its symptoms, according to information from the Utah Department of Health.
"We're really going to need time to say whether the outbreak is over," Eason said. "It could be decreasing or increasing over the next few months."
One hurdle to containing the spread of the virus, he said, is the inherent difficulty of contacting the homeless population's close contacts in order to inform them they could be at high risk of infection.