Florida has a hepatitis A crisis.
More Floridians have died from the highly infectious liver disease than any other state in the nation, except Kentucky, according to the federal Centers for Disease Control and Prevention.
Over the last two years, Florida has had 40 hepatitis A deaths compared to 61 deaths in Kentucky — with the two states accounting for about 40 percent of the 260 hepatitis A fatalities across the nation, the data shows.
Hepatitis A is spread by a vigorous virus that is more prevalent among a “high-risk” population that includes homeless Floridians and those who use illicit drugs, state health officials say.
And like the nation, where the hepatitis A outbreak has been clustered in a handful of states, Florida’s hardest hit regions have been in Central Florida, stretching from Tampa Bay east to Daytona Beach.
At the top of list is Pasco County.
The county leads the state with 391 hepatitis A cases since January, according to the Florida Department of Health. Pasco, the state’s 12th largest county, has seen its hepatitis A increase by six-fold over the prior year, when it had 66 cases.
It represents more than 15 percent of the 2,540 hepatitis A cases recorded this year in the state.
A Pasco firefighter contracted the disease; so did a food service worker at a Pasco County strip club, as well as several restaurant workers who got sick, according to news accounts this year.
In June, parents from Fivay High School in Hudson, were alerted to an “information letter,” from the Pasco health department, advising families that “Your child may have been exposed to a confirmed case of hepatitis A.”
Other counties along the Interstate 4 corridor have seen a sharp rise this year in hepatitis A cases.
Pinellas County has had 358 cases this year, a three-fold increase from 2018.
Hillsborough County cases rose to 138 so far this year, up from 84 cases last year. Volusia County at the other end of the I-4 corridor has seen its cases rise from five cases in 2018 to 229 cases this year.
Florida Surgeon General Scott Rivkees says the concentration of cases in Florida mirrors the national outbreak of hepatitis A cases.
Nationally, cases of the disease have been concentrated in states in the upper South and Midwest, with Kentucky leading the nation, followed by Ohio, West Virginia and Tennessee, according to CDC data.
Rivkees says a similar situation is happening along Florida’s I-4 corridor.
“It’s consistent with what’s seen in other areas where you have high-traffic corridors, we typically we see these outbreaks,” Rivkees said.
But at the same time, some of Florida’s largest counties have been spared from a major hepatitis A outbreak. Miami-Dade, the state’s largest county, has only recorded 30 hepatitis A cases this year, less than a tenth of the cases seen in Pasco County, the data shows.
Rivkees says the key is the use of a highly effective vaccine that can negate the outbreak if health officials can vaccinate enough of the high-risk population.
Having recently met with Miami-Dade heath officials, Rivkees says the county in early 2018 initiated a vaccination program to reach the high-risk population of homeless residents and residents who may be using illicit drugs.
“They launched a very aggressive hepatitis A vaccination campaign early on. And that may be one of the reasons why you’re seeing less hepatitis A there,” Rivkees told the state House Health Quality subcommittee earlier this week.
“I can’t emphasize enough that this is a vaccine-preventable disease. And if that is the primary factor, that really speaks to the importance of that.”
Although the Miami-Dade effort has been successful, Rivkees says there are many challenges connecting the vaccination program with a homeless and drug-using population that is not likely seeking regular medical care.
It has led to a series of innovations by state and local health officials to reach that population as well as spread the message that the disease can be stopped by vaccinations as well as increased hygiene efforts, such as hand washing or using bleach products to clean public restrooms daily.
For instance, in Pasco County, the local health department is setting up a mobile vaccination unit this Saturday at a Winn-Dixie store in Hudson to offer free hepatitis A vaccines as well as testing for HIV and hepatitis C.
In Pinellas County, local health officials are using “foot teams,” which carry vaccines and medical supplies in red wagons, to reach at-risk residents at places like bus stations and low-cost motels.
“The team provides information on hepatitis A and its risks to those they vaccinate as well as to those who decline the vaccine. Teams consist of nurses and disease control staff who keep track of inventory and consent forms,” according to a report from the Pinellas County Health Department.
Through mid-August, the teams have resulted in the vaccination of about 700 higher-risk residents, the agency said.
Rivkees said the vaccines are voluntary. But he said some health workers offer “incentives” like free bus passes or socks to individuals who might be at a higher risk for infection.
He also said health officials are working with other agencies and groups such as homeless coalitions that have are in regular contact with the higher-risk population. And he said health workers are also working with local sheriff’s departments and their jail populations, where many inmates are likely to have been homeless or drug users.
Rivkees estimates that Florida has just under 500,000 residents who fall into the high-risk category of the homeless and drug users. He said to get the outbreak under control, the state will have to vaccinate 80 percent of that population.
Although the state has recorded more than 250,000 vaccinations since the outbreak, Rivkees estimates a little over 20 percent of the higher-risk population has been vaccinated.
“We’re going to have to vaccinate 80 percent of the high-risk group before we’re going to start seeing a major decline,” Rivkees said.
He says in some counties with higher outbreaks, the vaccination level is higher and has resulted in some decline. “But this is going be a really considerable effort and it’s going to take us a while,” Rivkees said.
Health officials are also urging other residents who might face complications if they are infected to get vaccinations. They include more than 800,000 Floridians who have liver disease and residents over the age of 60 who have medical conditions like diabetes and heart disease.
Rivkees says vaccinations are generally covered by private insurance and programs like Medicare and Medicaid. But he says if residents don’t have insurance or are under-insured, they can get a free vaccination at their health departments.
Rivkees notes about 80 percent of the infected individuals in Florida require hospital care, which can cost an average of $77,000. But a vaccine costs less than $50, he says.
Hepatitis A can be contracted from person-to-person contact or indirectly if someone ingests fecal matter infected with the virus, state health officials say.
In addition to vaccines, the disease can be prevented through diligent hand-washing, particularly after using the bathroom, changing diapers or before preparing food, health officials say.
Food workers have been infected. Rivkees says there have been 21 cases where restaurant patrons have been notified that they ate in an establishment with an infected worker. But he says, thus far, the state has not discovered a case where an infected worker led to the infection of a customer.
The incident rate in Florida is highest among adults aged 30 years to 39. From January 2018 through July, those adults experienced a hepatitis A infection rate of 34 per 100,000 residents, according to state health data.