May 21, 2019

Hepatitis A in Caribou Update

Background

On Friday, May 17, the Maine Center for Disease Control and Prevention (Maine CDC) alerted Mainers to a confirmed case of acute hepatitis A in a food worker in Caribou. The case was infectious and handled food at Burger Boy restaurant from April 24 to May 13. In response to this case, Maine CDC issued guidance for those who visited the restaurant during the infectious period, and for health providers in this area.

To date, only one case of hepatitis A has been identified. This is not a disease outbreak. The risk of transmission of hepatitis A from the infected individual to others who may have worked at or visited the restaurant is low. However, it is the Maine CDC's responsibility to help to prevent further cases of hepatitis A by encouraging individuals who may have been exposed during the infectious period to review their vaccination history to determine if a vaccination is needed, as outlined below. As of today, those who visited the restaurant from May 7 to May 13 should consider receiving a hepatitis A vaccination, as there is a 14-day window during which prophylaxis is effective after exposure.

Know Your Vaccine History

Anyone exposed during the infectious period of April 24 to May 13 is encouraged to check their vaccination status and follow Maine CDC's recommended guidance regarding needed vaccination:

• Individuals who have received one hepatitis A vaccine shot in the past 10 years are protected, and no further vaccinations are necessary.
• Those who have received two hepatitis A vaccine shots are protected for life and no further vaccinations are needed.
• As of today, individuals who visited the restaurant from May 7 to May 13 and received one hepatitis A vaccine shot longer than 10 years ago should receive a booster.
• Those who visited from April 24 to May 6 and received one hepatitis shot longer than 10 years ago are now outside the window during which the booster is effective, and should contact their health care provider if symptoms develop.
• Individuals unsure of their vaccination history should receive a hepatitis A shot.
• Those who visited the restaurant before April 24 or after May 13 are not at risk of exposure from this case.

Hepatitis A - The Disease

Hepatitis A is a vaccine-preventable liver disease caused by hepatitis A virus. Hepatitis A can be spread through contaminated food or water, especially in food prepared by a person who is infected. Symptoms begin to show 15-50 days after exposure to the virus. An infected person can spread the virus to others approximately two weeks before symptoms start and until one week after symptoms begin. Symptoms range from mild illness to severe illness that may require hospitalization. Most adults with hepatitis A have a sudden onset of symptoms such as tiredness, low appetite, stomach pain, nausea, dark urine, and jaundice (yellowing of the skin and eyes). The infection can last several months. Most children younger than six years of age do not have symptoms or have an unrecognized infection. The best way to prevent hepatitis A infection is to get vaccinated.

No New Cases of Hepatitis A Identified to Date

Since Friday, May 17, Maine CDC has worked closely with community partners, health care providers, and the public to ensure Mainers are protected. Maine CDC infectious disease epidemiologists have interviewed people who had contact with the case, responded to over 30 consultation requests, and communicated with healthcare facilities in Aroostook County. These epidemiologists have also been conducting surveillance, or monitoring to see if other cases of hepatitis A in the area have been identified, by reviewing the number of emergency room visits related to hepatitis A. No new cases have been identified at this time.

Vaccine Availability

On Monday, May 20, the CDC's Maine Immunization Program (MIP) placed an emergency order with federal CDC for 1,500 doses of hepatitis A vaccine to aid area hospitals and healthcare facilities in their immunization efforts. The shipment is scheduled to be delivered today. This vaccine will be supplied to clinics for under- and uninsured adults and children. Providers are required to inquire about the insurance status of patients they see, as federal funding dictates the populations for which CDC-supplied vaccine may be used. MIP will continue to work with area providers to assess and maintain vaccine supply as needed.

MIP has also recommended that health providers check ImmPact, the Maine Immunization Information System, to determine whether patients may need to obtain additional vaccinations.

Public Health Nurses On-Site for Vaccine Clinics

Maine CDC's Public Health Nursing Program (PHN) continues to assist with phone calls related to this case and provide assistance as needed. PHN is working to facilitate vaccine administration to adults and children, and on Monday, two public health nurses assisted at vaccine clinics at Northern Light A.R. Gould Hospital and Cary Medical Center. Four public health nurses will be on-site in Caribou on Tuesday, May 21 to assist with clinics. For more information on these clinics, please call 1-888-644-1130.

Maine CDC will continue to work with valued partners in the community to provide support and facilitate vaccination.

For more information on hepatitis A, please visit: www.cdc.gov/hepatitis/hav/index.htm