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Metro Public Health Department Hepatitis A Outbreak Update

6/27/2018

Updated July 11, 2018 to reflect the total number of confirmed cases to 48.

48 Confirmed Hepatitis A Cases in Nashville Since December 2017
MPHD Continues Focus on Offering Vaccine to At-Risk Populations

Metro Public Health Department (MPHD) officials today confirmed 48 cases of hepatitis A have occurred in Nashville since December 2017. MPHD continues to work with the Tennessee Department of Health (TDH), as well as other Metro Departments and community organizations in response to the outbreak.

"Metro Public Health Department staff, working with multiple community partners, continue to plan additional opportunities to offer the hepatitis A vaccine to the at-risk communities," said Rachel Franklin, Interim Director of Communicable Disease and Emergency Preparedness. "This week we added three vaccination clinics to reach people experiencing homelessness. Our staff vaccinated nearly 200 among the at-risk group at last weekend's PRIDE Festival and we are planning additional locations to offer the vaccine in the coming weeks to reach the MSM community."

The Health Department has worked with the Metropolitan Homelessness Commission staff on a hepatitis A vaccine campaign to reach the homeless. That initial vaccination effort began June 18 and will run through July 6. The Health Department added three additional locations since last week, including the Room in the Inn and the Nashville Rescue Mission. The homeless outreach is in addition to the ongoing vaccination efforts at MPHD clinics and Neighborhood Health clinics.

  • Wednesday, June 27: Downtown Library (3rd Floor Commons 9:00 a.m. - Noon)
  • Friday, June 29 (9:00 a.m. - 11:00 a.m.): Caldwell Park, 4905 Edmonson Pike, Nashville 37211
  • Friday, June 29 (8:00 a.m. - 1:00 p.m.): Room in the Inn, 705 Drexel St, Nashville 37203
  • Monday, July 2 (9:00 a.m. - 11:00 a.m.): City Road Chapel (Quiet Room), 701 Gallatin Road South, Madison 37115
  • Friday, July 6 (9:00 a.m. - 12:00 p.m.): Community Care Fellowship (Ken & Carol's), 511 South 8th Street, Nashville 37206
  • Monday, July 9 (2:00 a.m. - 6:00 p.m.): Nashville Rescue Mission, 639 Lafayette St, Nashville 37203

The Health Department worked with the Davidson County Sheriff's Office to offer hepatitis A vaccine at all DCSO facilities after four cases of hepatitis A were confirmed among DCSO inmates three weeks ago. Health officials offered hepatitis A vaccine to inmates housed in DCSO facilities, as well as DCSO public safety staff. MPHD and DCSO are working on a plan to offer hepatitis A vaccine when a person in custody enters a DCSO facility.

As a result of the confirmed cases, all DCSO inmates will undergo a screening prior to being taken to any scheduled appointments or court dates. If they are found to have any signs or symptoms, they will be isolated and will not leave the facility until they have been cleared by medical staff.

Large hepatitis A outbreaks have occurred since early 2017 in several states, including ongoing outbreaks in California, Utah, Kentucky, Indiana and West Virginia, spreading from person to person primarily among people who are homeless and people who use illicit drugs. According to the Centers for Disease Control and Prevention (CDC), those at greatest risk of exposure to hepatitis A in the current outbreaks include:

  • People who use drugs (not just injection drug use)
  • Men who have sexual contact with men
  • Individuals experiencing homelessness

MPHD is working with TDH and the Centers for Disease Control and Prevention (CDC) on testing specimens collected from those confirmed as having hep A. MPHD has received confirmation from the CDC that genotype test results from one of the samples in Nashville matched the strain of hepatitis A found in the recent outbreaks around the country.

MPHD continues to offer free hepatitis A vaccine at all three of its Health Centers to the three risk groups. MPHD continues to receive additional doses of hepatitis A vaccine from TDH and more vaccine is available as needed.

MPHD operates three health centers open 8:00 a.m. to 4:00 p.m. Monday through Friday:

  • East Health Center, 1015 East Trinity Lane
  • Lentz Health Center, 2500 Charlotte Avenue
  • Woodbine Health Center, 224 Oriel Avenue

An agreement with Neighborhood Health has been established to provide hepatitis A vaccine to those in the three at-risk groups. Neighborhood Health locations and hours of operation are as follows:

  • Downtown Clinic, 526 8th Avenue South (adjacent to the Room in the Inn campus)
    8:00 a.m. to 5:00 p.m., Monday through Friday
  • Madison Clinic, 601 W. Due West Avenue
    8:00 a.m. to 10:00 p.m., Monday through Friday and 8:00 a.m. to 4:00 p.m. Saturday
  • My House Clinic, 442 Metroplex Dr. Building D, Suite 200
    8:00 a.m. to 5:00 p.m., Monday through Thursday and 10:00 a.m. to 7:00 p.m. Friday

Walk-ins are welcome. Appointments can be made with Neighborhood Health by calling 615-227-3000.

MPHD has hepatitis A vaccine available for children and adults. Since 2006, the CDC has recommended all young children routinely be vaccinated against hepatitis A, and the vaccine has been required for daycare and kindergarten entry in Tennessee since 2011. All children under 19 years old who do not have private insurance coverage for vaccines, including uninsured and TennCare-eligible children, may be vaccinated through the Vaccines for Children (VFC) program by their health care provider or at any local health department. The cost for vaccine is $40.00 for children not eligible for the VFC program who are 18 years old and younger.

The vaccine can also be found at area health care providers in Nashville for those with insurance. Many insurance plans cover the costs of hepatitis A vaccine without a deductible or co-pay, if administered by an in-network health care provider.

MPHD has been sending Health Alerts to health care providers in Nashville about the current hepatitis A outbreak, a reminder about the symptoms, and how they should report cases to MPHD.

MPHD has initiated a community awareness campaign focusing on outbreak updates and steps to follow to prevent exposure to hepatitis A. Updates and prevention messaging, such as the importance of hand washing and the use of a vaccine to protect against the virus for those at risk, can be found at www.nashville.gov/Health-Department.

MPHD produced hand-washing messages that are currently running on video screens at the Nashville International Airport's baggage claim area reminding music festival goers about the importance of hand-washing to stop the spread of germs.

Hepatitis A is a vaccine-preventable liver disease caused by the hepatitis A virus. Common symptoms include: fever, nausea, vomiting, abdominal pain, dark urine, jaundice (yellowing of eyes and skin), and clay-colored stools. The disease can be severe in some people, possibly requiring hospitalization. Most recover completely within a few weeks. Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill. The best way to prevent hepatitis A is through vaccination.

For more information visit cdc.gov/hepatitis

The mission of the Metro Public Health Department (MPHD) is to protect, improve, and sustain health and well-being for all people in Metropolitan Nashville. More than 450 Health Department employees provide essential public health services for the resident population of more than 600,000 people, with a total Department budget of more than $60 million. Our three public health centers, nutrition center, and Metro Animal Care and Control provide services and programs throughout a diverse and growing community.

As Nashville's local Health Department, we connect people to essential public health services, we enforce health regulations, and we lead and participate in collaborative efforts to create healthy conditions for everyone in Nashville. To keep up with the latest information about MPHD visit our website at health.nashville.gov or follow us on Facebook (facebook.com/MPHDNashville) and Twitter (@NashvilleHealth).