Hospitals may see jump in hepatitis A admissions
Young children, homosexuals at high risk
While the AIDS crisis persuaded many gay men to cast aside the dangerous practice of unprotected anal intercourse, some traded it in for another hazardous habit: rimming. That is, oral-anal contact. And the result in at least one American city Atlanta is an outbreak of hepatitis A, a disease spread via the fecal-oral route. "I had seven hepatitis A cases reported to me last year and four the year before that," says Robert Felton, MS, a county epidemiologist in Atlanta. "This year I have 167 cases. Now not all of those are gay, but a substantial number are."
There’s nothing new about gay men contracting hepatitis A. The Centers for Disease Control and Prevention in Atlanta first noticed a sharp rise in the number of hepatitis A cases among homosexual and bisexual men in 1992. What is new are two vaccines now available to prevent the disease Heptavax and Vaqta that are proving highly effective in the field.
Administration of the vaccine dramatically curbed a recent outbreak of hepatitis A in Alaska, for example. Researchers vaccinated nearly 5,000 people at risk of contracting the disease and saw the epidemic cease in a few months in places where most of the population had been vaccinated. By comparison, it took another year for the virus to spend itself in Alaskan communities with lesser rates of vaccination.
In Memphis, TN, where a hepatitis A epidemic has been raging for more than two years, a vaccination program has helped cut the number of reported cases of the disease from a high of 162 cases per 100,000 in October 1995, to less than half that now. That’s still 10 times higher than the normal rate of hepatitis A for the city, but Denise Shockwell, MS, epidemiologist with the Memphis Department of Public Health says it’s a big improvement. "The decline is due to two factors," she says. "Fewer susceptible people and the vaccine."
Day care is infection source
The Alaskan outback and Memphis aren’t exactly hotbeds of homosexual activity, and that brings up an important point about hepatitis A. It’s not a "gay" disease nor one usually transmitted by sexual activity. In fact, some of the biggest carriers of the disease are waddling around day-care centers in diapers.
"Most of our cases occur in day-care centers or in association with day-care centers," says Shockwell. "We have seen very little homosexual involvement." Shockwell says poor hygiene in the centers not disinfecting the diaper-changing table, for example is one way to spread the disease. Another is the proclivity for children to put everything in their mouths.
But by and large, infants don’t get sick from hepatitis A. Instead, they carry the virus home and infect other family members, who then get sick. Often, that’s how a hepatitis A carrier is finally detected. "You can then get a vague symptom history [on the infant]," Shockwell says. "Maybe one day of diarrhea or fatigue."
In adults and older children the symptoms can be more dramatic. While hepatitis A isn’t as severe a disease as its bloodborne cousin, hepatitis B, it can still land its victims in the hospital. In Memphis, 18% of hepatitis A cases have required hospitalization, and Shockwell says symptoms of the disease fatigue, jaundice, fever can linger for up to a year. Few fatalities result from hepatitis A, but since bed rest is the only treatment for the disease once it develops, long absences from work are the norm; two to six weeks isn’t uncommon, says Shockwell. (See fact box, above.
One important rule: Wash your hands
For health care professionals caring for hepatitis A patients, there’s one overwhelming piece of advice: Wash your hands frequently and thoroughly. "As long as universal precautions are used, [including] proper washing, the risk to health care workers is small," says Shockwell. Even in Memphis, where one in five hospitalizations are due to hepatitis A, there’s no plan to mass-vaccinate health care workers.
In Atlanta, officials expect otherwise healthy gay men will likely recover from hepatitis A and that the spread of the disease will be halted on the heels of a major vaccination campaign, partially carried out via mobile clinics. Felton says it’s one of the most successful vaccination campaigns ever conducted in that city.
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