Q&A: Hepatitis A outbreak in WAVE Country

Q&A: Hepatitis A outbreak in WAVE Country
Hepatitis A vaccinations.
Lori Caloia, the Medical Director at the Louisville Metro Department of Public Health and Wellness (Source :WAVE 3 News)
Lori Caloia, the Medical Director at the Louisville Metro Department of Public Health and Wellness (Source :WAVE 3 News)

LOUISVILLE, KY (WAVE) - Lori Caloia, the Medical Director at the Louisville Metro Department of Public Health and Wellness, answered 10 questions WAVE 3 News staff members and viewers had about hepatitis A outbreaks in the Louisville Metro area.

Can you give us an update related to hepatitis A outbreaks? What's the scale like? How have things progressed over time?

A: Right now, we're standing at about 252 cases. That was last Friday, April 20. So, things are definitely continuing. We haven't seen a slowdown yet of our cases, but hopefully we'll see that soon.

What needs to happen for the outbreaks to slow down? How long will they continue? 

A: We expect they're going to continue to be at least several more months of the outbreak. This is what we've seen in other places, such as San Diego and Michigan, that've also had outbreaks. Unfortunately, I think our work is not over yet. I think we have at least several months in the future that we'll continue to work on this. We continue vaccinating the high-risk populations, which include primarily people who use illicit drugs and our homeless population in Louisville. If we can get as many of those people vaccinated as possible, we can hopefully help curb the outbreak.

Indiana health officials put out a travel advisory that encouraged people traveling to Kentucky to get vaccinated. What are your thoughts on that? And, if they're telling everybody coming in to get vaccinated, should everyone here be doing the same?

A: As a public health official, I'm always a proponent of vaccine, when we have a vaccine that could prevent something that you might get otherwise, if you're not yet vaccinated. From that perspective, I certainly think it's a good idea against hepatitis A or other vaccine-preventable illnesses. It's important to note that the Center for Disease Control and Prevention has not necessarily recommended that people traveling to states where there are hepatitis A outbreaks going on get vaccinated. That's not necessarily their criteria. On their website, they recommend anyone wishing to be immune to hepatitis A should get vaccinated. Again, if you can get vaccinated, why not, but that has less to do with the outbreak than keeping yourself healthy.

If someone is interested in getting a vaccine, where can they do it? Is it covered under most people's health insurance? Are there shortages?

A: Most health insurers cover the vaccine. I think it's important to note, there is plenty of vaccine out there. There haven't been any shortages of vaccine. There are some inconsistencies. For example, one insurer might recommend you do it at your pharmacist, while another might say you should go to your primary care provider's office. So, the quickest thing to do is to call the phone number on your insurance card and find out where your insurance wants you to get the vaccine. Some of the pharmacies will even run your insurance before you get there to make sure you're covered at their location. That might save people a trip or some disappointment.

Is the hepatitis A vaccine safe for women who are pregnant?

A: The Center for Disease Control recently updated their recommendation that pregnant women can get vaccinated against hepatitis A. It's a safe vaccine. It's a dead virus vaccine. The main vaccines that we avoid during pregnancy are live virus vaccines. So, measles, mumps, rubella and varicella are the ones that people would not want to get while they're pregnant.

How does the vaccine that covers both hepatitis A and B work?

A: Most people at the age of 25 and even beyond that were vaccinated against hepatitis B, when they were younger. So, they would not necessarily need that vaccine, unless they know they haven't been vaccinated. For hepatitis A, a lot of children have been getting that vaccine as well. That vaccine has been out on the market since the late 1990s and has been more mainstream since the mid-2000s. Many kids have already been vaccinated against that as well. The combination vaccine is a little bit different than the A vaccine alone. For the A vaccine, you have to get one shot, six months later, you get a second. The combination hepatitis A and B vaccine you get one shot, one month later, you get a second shot, and then, six months from the original, you get a third. So, it's a three-part series.

If you get the hepatitis A vaccine, are you protected for life?

A: Generally, we consider the immunity to be a long time. A lot of the studies don't go beyond 20 to 25 years. So, they base things on models. It looks like it lasts for at least that long. Probably much longer than that.

How can you find out if you've been vaccinated?

A: You can go back and try to find your vaccine records. That would tell you, for sure, if you got those vaccines or not. You might have to hunt back pretty far to find those things, if you don't keep good records at home. The other thing doctor's offices can do is sometimes draw a titer. The titers can be pretty expensive, and they're not always covered by insurance.

Can you get vaccinated twice? Is that safe?

A: It's not going to hurt to get a vaccine if you're not sure, especially if its been years and years or you're not going to be able to find those records.

What are the requirements for students attending Kentucky schools?

A: As of October, before the outbreak even happened with hepatitis A, the state of Kentucky mandated hepatitis A vaccines for all students entering school. So, during the 2018-2019 school year, all kids will have to have those two hepatitis A vaccines before starting school. If they're not able to get both of those vaccines, they can get what's called a provisional certificate, where they can get the first vaccine, and then, six months later, they have to go ahead and get the second.

This interview has been edited for clarity.

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