In accordance with 902 KAR 2:020, cases of acute hepatitis A should be reported within 24 hours.

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Kentucky Department for Public Health KY7-89 - Acute Hepatitis A Outbreak Weekly Report Morbidity and Mortality Weekly Report (MMWR) Week June, 8 June 9, 8 Brief Description of Outbreak: In November

1 Kentucky Department for Public Health KY Acute Hepatitis A Outbreak Weekly Report Morbidity and Mortality Weekly Report (MMWR) Week June, 8 June 9, 8 Brief Description of Outbreak: In November 7, the Kentucky Department for Public Health (DPH) identified an outbreak of acute hepatitis A. The increase in observed in Kentucky was well over the -year average of reported hepatitis A, and several have been infected with hepatitis A virus (HAV) strains genetically linked to outbreaks in California, Utah, and Michigan. Similar to hepatitis A outbreaks in other states, the primary risk factors have been homelessness and illicit drug use. A contaminated food source has not been identified, and HAV transmission is believed to have occurred through person-to-person contact. Below is a weekly and cumulative update on the outbreak. In accordance with 9 KAR :, of acute hepatitis A should be reported within hours. The case definition used for outbreak-associated acute hepatitis A is available upon request. Table : Summary of Outbreak-Associated Acute Hepatitis A Cases Update for Week : Update Total for Weeks -: new (n=7): Confirmed - Probable - Suspect - Total number of (n=8): Confirmed - Probable - Suspected - 99 counties with new : Total number of counties with : (% of KY counties) with specimens submitted for genotyping where results are available: with specimens submitted for genotyping where results are available: (8%) with genotype IB among those with genotype testing: Total number of with genotype IB among those with genotype testing: (9% of those tested) Hospitalizations: Total Hospitalizations: 9 (9%) deaths Reported*: Total number of deaths reported*: 6 (<%) * Deaths are defined as any outbreak-associated acute hepatitis A case with documentation of hepatitis A as a contributing factor to the individual s death.

2 Table : Cumulative Distribution of Cases by County KY7-89 Distribution Of Outbreak-Associated Acute Hepatitis A Cases, by County, August, 7 June 9, 8*^# County Total number of reported confirmed probable suspected Incident Rate per, population Adair^. Allen^.8 Anderson 8.9 Ballard 9.8 Barren. Boone.8 Bourbon. Boyd 98. Boyle 6.7 Bullitt Campbell. Carter 6 6. Casey 6. Elliott^ 6.6 Estill 7. Fayette. Floyd.8 Franklin. Garrard^. Grant. Grayson.

3 KY7-89 Distribution Of Outbreak-Associated Acute Hepatitis A Cases, by County, August, 7 June 9, 8*^# County Total number of reported confirmed probable suspected Incident Rate per, population Greenup Hardin Henry 8.7 Hopkins. Jefferson Jessamine.7 Kenton. Laurel. Lawrence 9. Leslie 9.7 Lincoln 8. Madison. Marion. Marshall. Martin^ 8.7 McCracken 6. Meade. Montgomery Nelson 8 7. Ohio. Oldham 6. Pendleton 6.9 Powell 6.

4 KY7-89 Distribution Of Outbreak-Associated Acute Hepatitis A Cases, by County, August, 7 June 9, 8*^# County Total number of reported confirmed probable suspected Incident Rate per, population Pulaski.6 Rowan 6. Russell.6 Shelby. Spencer.6 Taylor.7 Warren Whitley.8 Total Cases: * Cases are reported based on date of specimen collection. ^ Denotes a county where have not been previously identified. # As genotyping results become available, may be excluded if they do not meet the outbreak case definition. Cases in the following counties have been excluded from the outbreak case count this week: None.

5 Figure : Geographic Distribution of Outbreak-Associated Cases by County

6 Figure : Major Interstates and Syringe Exchange Programs in Counties Reporting Outbreak-Associated Cases 6

7 reported Figure : Outbreak-Associated Cases by Age KY7-89 Outbreak-Associated Cases of Acute Hepatitis A in Kentucky, by Age, August, 7 - June 9, Age Range (years) * * The mean age of is 8.8 years, and the median age is 7. years. Table : Frequent Risk Factors of Outbreak-associated Cases KY7-89 Risk Factors of Outbreak-Associated Acute Hepatitis A Cases*, August, 7 June 9, 8 Risk Factor Cases Reporting Risk Factor (n=)* Homelessness only (%) Illicit drug use only 8 (7%) Homelessness + illicit drug use 8 (%) MSM only (<%) No Risk Factors (9%) * Risk factor information is unavailable for 89 (%) of all outbreak associated. 7

8 Jul 9 - Aug () Aug 6 - Aug () Aug - Aug 9 () Aug - Aug 6 () Aug 7 - Sep () Sep - Sep 9 (6) Sep - Sep 6 (7) Sep 7 - Sep (8) Sep - Sep (9) Oct - Oct 7 () Oct 8 - Oct () Oct - Oct () Oct - Oct 8 () Oct 9 - Nov () Nov - Nov () Nov - Nov 8 (6) Nov 9 - Nov (7) Nov 6 - Dec (8) Dec - Dec 9 (9) Dec - Dec 6 () Dec 7 - Dec () Dec - Dec () Dec - Jan 6 () Jan 7 - Jan () Jan - Jan () Jan - Jan 7 () Jan 8 - Feb () Feb - Feb (6) Feb - Feb 7 (7) Feb 8 - Feb (8) Feb - Mar (9) Mar - Mar () Mar - Mar 7 () Mar 8 - Mar () Mar - Mar () Apr - Apr 7 () Apr 8 - Apr () Apr - Apr (6) Apr - Apr 8 (7) Apr 9 - May (8) May 6 - May (9) May - May 9 () May - May 6 () May 7 - Jun () Jun - Jun 9 () Jun - Jun 6 () Jun 7 - June () Jun - Jun (6) Jul - Jul 7 (7) Cases Figure : Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases 9 KY7-89 Epi-Curve of Outbreak-Associated Cases by MMWR Week, August, 7 - June 9, MMWR Week* * MMWR weeks are based on date of specimen collection. 8

9 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Figure : Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases by Month of Onset KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, August, 7 - June 9, 8 (Current month shown in gold - case counts are not complete) * Date of onset has been reported for 8.% (or 67/8) of. 9

10 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Cases Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Cases Figures 6-9: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least reported, by Month of Onset (Counties include Boyd, Bullitt, Carter, and Greenup Counties) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Boyd County, August, 7 - June 9, 8 (N=88) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Bullitt County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Carter County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Greenup County, August, 7 - June 9, 8 (N=) 6 8 6

11 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Cases Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Cases Figures -: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least reported, by Month of Onset (Counties include Hardin, Jefferson, Montgomery, and Nelson Counties) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Hardin County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Jefferson County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Montgomery County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Nelson County, August, 7 - June 9, 8 (N=) 8 7 6

12 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Jul 7 Aug 7 Sep 7 Oct 7 Nov 7 Dec 7 Jan 8 Feb 8 Mar 8 Apr 8 May 8 Jun 8 Jul 8 Aug 8 Cases Cases Figure -6: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least reported, by Month of Onset (Shelby, Warren, and Whitley Counties) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Shelby County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Warren County, August, 7 - June 9, 8 (N=) KY7-89 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Whitley County, August, 7 - June 9, 8 (N=)

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