Week 1, Sept. 3-9, 2017:
One case of hepatitis A
Rui Zhao hunkers behind his twin computer monitors. Most visitors to the epidemiologist’s uncomfortably cramped office talk to his brow and the short black hair on the top of his head. They may glimpse his eyes when he looks up from his screens. On the wall to his left are small stuffed toys of irregular shapes, each a cuddly version of some nasty germ. From this third-floor office at the Louisville Metro Department of Public Health and Wellness, Zhao watches other germs work their way across Louisville. In the 90-degree days of early September, it’s a bit too soon to think about influenza, which will sweep through nursing homes in cold weather, taking lives as it does most every year. More of interest now: the chronic liver diseases hepatitis B and C. In fact, cases of hepatitis B are dancing upward in the metro area. Hepatitis C is already considered an epidemic, although the number of new cases is tiny.
Of hepatitis A, there’s a single case. And there’s no case the following week. It’s meaningless noise in the ebb and flow of the 25 or so infectious diseases surveilled by the state. Each year, one or two people in the city — and, rarely, as many as five — will contract the hepatitis A virus. They travel to a country where it’s common, endemic. They bring it home from mission trips or as a souvenir from an exotic vacation. More frequently, travelers never know they have it. About 30 percent of adults with hepatitis A produce no symptoms.
But for the unlucky, it can be brutal, bringing low-grade fever, headache, weakness and exhaustion, diarrhea, sudden nausea and vomiting, and abdominal pain, especially under the ribs on the right side, where the liver sits. Stools turn pale and urine dark. There may be intense itching. The white of the eye and skin often yellow, another sign that the virus is in the liver. And that’s the end of it, usually. Unlike hepatitis B and C, hepatitis A doesn’t settle in for a lifetime, grinding away at the liver. Uncomfortable? Absolutely. Miserable? Often. Life-threatening? Only in people older than 50 and those with other health problems. And it’s self-resolving, with no cure but time. It’s also highly contagious, most likely to spread while its host feels tip-top, before discomfort sets in. Any virus shed during infection lingers on surfaces for months. It is frequently transmitted by food, and while it succumbs to soap and water, or near-boiling temperatures, gel sanitizers can’t touch it.
Hepatitis B and C, on the other hand, infect via body fluids like blood, semen or vaginal secretions — the same pathways taken by the virus that causes AIDS. Since February 2017, a combined hepatitis A-B vaccine has been offered to visitors at the syringe-exchange sites operated by Metro Health and Wellness. There is no vaccine against the relatively new virus hepatitis C, which was discovered in 1989 and originally called non-A, non-B hepatitis. The syringe-exchange clinic is one sure way for the health department to reach a group of people normally driven into the shadows, a population vulnerable to a variety of diseases.
The importance of such contact is about to increase. The question is, will it be enough? By April, few will think so.
Weeks 2-5, Sept. 10-Oct. 7:
Three new cases of hepatitis A. Total: 4
The Courier Journal is full of the troubles facing the University of Louisville basketball program as October rolls in with 70- and 80-degree days and enough sunshine to convince anyone that summer will stretch on forever. Zhao notes that hepatitis A cases are now double the number seen in a normal year. But whether those four cases are significant isn’t clear. There’s also an unusual surge in false-positive hep A tests. He always sees a few. Every year, three or four people will test positive, yet their illness makes no sense. Usually, these cases of mistaken viral identity involve women 60 and older who have symptoms that would fit any number of diseases, including hepatitis A. It’s essentially a bad joke played by an aging immune system. Immune defenses lose precision with each passing year; our bodies are more prone to interpret any number of ailments as an attack on the liver and ramp up antibody production to fight a phantom infection.
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