SMDHU associate medical officer of health sheds light on Hepatitis A outbreak

Earlier this month, the Simcoe Muskoka District Health Unit (SMDHU) reported an unusually high number of Hepatitis A cases in the region, specifically in the area from just north of Gravenhurst to Huntsville.

You may be wondering how the outbreak began, how it spread, and what you can do to protect yourself. Huntsville Doppler spoke with Dr. Colin Lee, SMDHU associate medical officer of health, for the answers.

How common is Hepatitis A in Simcoe Muskoka?

The region sees very few cases in a typical year—between zero and six.

Since October 2019, 13 cases have been identified in the area between Gravenhurst and Huntsville, an uncommon number for this region.

How did this outbreak start and how has it spread?

Through its investigation, SMDHU determined that the index case—the first person to become ill in this outbreak—likely acquired the virus through travel outside of Canada.

“Most of the time, [local cases develop] because a traveller has gone to a country where the hygienic standards are not as high and also where there is more Hepatitis A,” said Dr. Lee. But symptoms may not appear until several weeks after the infected person returns home. “It seems that the person has passed on the infection to the community via that person’s social interactions.”

[Update March 12, 2020: In an emailed response from the SMDHU media co-ordinator to a follow-up question about the spread of the virus, Dr. Lee told Huntsville Doppler, “The hepatitis A outbreak north of Gravenhurst to Huntsville itself is continuing. Other than knowing that the first case was a result of a returning traveler, and there are a few cases who resided in the same household, we do not know firmly where the other cases have contracted the disease.”]

Hepatitis A is “contracted because someone has put something in their mouth, whether it be food or their hand, that has been contaminated by virus from an infected persons feces… and, so, it is alarming that we have so many cases,” he added.

What does the health unit do if it receives a report of Hepatitis A?

When the SMDHU receives a report about a Hepatitis A case, it has two goals, said Dr. Lee.

First, it wants to ensure that person doesn’t infect anyone else. That usually means they are asked to stay at home.

Second, they want to inform anyone who has been in close contact with that person so that if they develop symptoms they can seek medical attention and be tested. And if that contact was less than 14 days previous, so that they can consider getting a vaccine that will decrease their chance of becoming ill by up to 85 per cent.

If the health unit can determine who the infected person may have been in close enough contact with to be at risk from the virus, it will reach out to those people directly with information and recommendations.

In cases where it is not easy to determine who the infected person may have been in close contact with, the health unit will share details publicly in order to inform anyone potentially at risk to watch for symptoms and to consider getting the Hepatitis A vaccine.

To protect privacy, the health unit will only release information to the extent necessary for public health, said Dr. Lee.

How did SMDHU report this outbreak?

In early March, SMDHU notified the public about the outbreak and provided information about preventive measures and symptoms. Twelve cases had been identified by that time.

In most of the cases that have been identified to date, the health unit has been able to identify the people who had been in close enough contact with the infected person to be at risk of infection themselves. Health officials then notified those people with recommended actions. Dr. Lee confirmed that one of the cases was in a classroom at a local school.

On March 11, SMDHU released some information about a specific case because the person’s employment at a Huntsville restaurant meant that it could not identify all of the people who may have been in close enough contact with the infected person, said Dr. Lee.

“We are working very hard to to try to decrease the number of cases we’re seeing in this geography,” he added. “The restaurant has been exemplary in working with us, and it has certainly passed all inspections and standards that we require.”

As of time of publication, there have been 13 cases identified, said Dr. Lee.

What can people do to protect themselves from the Hepatitis A virus?

“Be vigilant when you’re going to the washroom, in your hand washing,” said Dr. Lee. “Be vigilant when you’re handling a baby’s diapers or other people’s diapers. Be vigilant to wash your fruits and vegetables carefully and also before eating. And if you’ve not previously been immunized for Hepatitis A, there is the opportunity to be immunized before you meet the virus.”

Hepatitis A vaccines are not publicly funded, noted Dr. Lee, except for those people who are drug users, who have declared themselves as men who have sex with men, or those who have severe liver disease. Some extended health plans provide coverage for the cost of the vaccine. Depending on the vaccine, it generally requires two to three shots over the course of six months and offers a lifetime of protection against the virus. It is available through healthcare providers and some pharmacies.

For those who may have been in contact with the restaurant employee, free immunization clinics are being held at the Active Living Centre, located at the back of the Summit Centre, (20 Park Drive, Huntsville) on Thursday, March 12 from 10 a.m. to 8 p.m. and on Friday, March 13 from 10 a.m. to 3 p.m.

Know the ABCs (of Hepatitis)

There is more than one type of Hepatitis virus.

Hepatitis A—the type that the health unit has reported an outbreak of—is caused by the Hepatitis A virus (HAV), which is found in the feces of HAV-infected people. According to the SMDHU website, “People who are infected with Hepatitis A pass the virus in their stool and the virus can get on food, drink, surfaces and objects that you come into contact with every day. An infected food handler who does not properly wash their hands may spread the virus to foods they touch. You may also be exposed to the virus if you are in direct contact with the stool of an ill person and then do not wash your hands thoroughly. For example, changing diapers of children or seniors. In addition, some sexual activities may expose you to Hepatitis A. The virus can also get into your body by drinking or swimming in water that has the virus.”

Symptoms of Hepatitis A include “a general feeling of being unwell, loss of appetite, nausea and stomach pain, then a few days later have jaundice (yellowness of the skin and/or eyes). Dark urine and light-coloured stools, as well as severe itching of the skin, may occur. These symptoms usually appear 28 to 30 days after you come in contact with the virus, but may show up as early as 15 days or as long as 50 days after you come in contact with the virus.” Small children usually have mild or no symptoms.

There is no treatment for Hepatitis A and most people recover at home.

The Hepatitis B virus spreads through contact with the blood, semen, vaginal fluid, and/or saliva of an infected person. This happens most commonly by having sex with an infected partner.

Hepatitis C is largely a blood-borne disease, said Dr. Lee, and can be transmitted in situations like tattooing equipment that hasn’t been properly sterilized, or sharing of needles and syringes.

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