![]() An identical genotype IB sequence was identified in eight of the nine specimens submitted from the restaurant outbreak and from all five sequenced community case specimens.Īlthough a clear temporal association between the restaurant outbreak and two of the community cases was demonstrated, limited contact information for most of the persons with community-acquired cases hampered the ability to conclusively identify an epidemiologic link between the restaurant outbreak and sustained person-to-person community transmission. Sustained community transmission continued into 2022, with 98 total cases reported through September 2022, including 64 hospitalizations ( Figure). By the end of 2021, 13 additional cases were reported to RCAHD. ![]() In October 2021, RCAHD began to receive reports of hepatitis A cases that were not directly associated with the index patient or restaurant outbreak. Sustained Community Transmission (Ongoing) ![]() A community-acquired case of hepatitis A was defined as an illness meeting the CSTE confirmed case criteria of hepatitis A in a person who did not dine at any of the restaurants during the exposure period, and had no contact with a patient who did dine at any of the restaurants during September 2021–September 2022.The figure is a histogram showing confirmed hepatitis A cases, by surveillance week of diagnosis and outbreak classification, in Virginia during September 2021–September 2022. * A restaurant-associated case of hepatitis A was defined as an illness meeting the Council of State and Territorial Epidemiologists (CSTE) confirmed case criteria ( ) in a person who dined at any of the three restaurant locations during August 10–26, 2021, or who had close contact with the index patient. † The median patient age was 64 years (range = 30–86 years) ( Table).Ĭonfirmed hepatitis A cases (N = 149), by surveillance week of diagnosis and outbreak classification*- Virginia, September 2021–September 2022Ībbreviation: CSTE = Council of State and Territorial Epidemiologists. When the outbreak investigation was closed on November 20, 2021, 51 restaurant-associated cases had been identified ( Figure). Based on the index patient’s symptom onset date and last day worked, the exposure period for patrons who ate at any of the three restaurants was determined to be August 10–26, 2021. Further investigation identified the index patient as an unvaccinated food handler who had risk factors for hepatitis A and who had worked at three locations of the same restaurant chain however, this person delayed seeking medical attention for more than 2 weeks after symptom onset and did not disclose being employed as a food handler at that time. Initial case investigations identified a local restaurant chain as a common source of exposure. In mid-September 2021, however, five hepatitis A cases were reported during a single week. The districts have previously experienced a low hepatitis A incidence, with only six cases reported during January 1, 2019–December 31, 2020, and none through August 2021. RCAHD serves a population of approximately 280,000 persons. Initial Outbreak Investigation (September–November 2021) Strengthening community partnerships between public health officials and organizations that employ persons with risk factors for acquisition of HAV could help to prevent infections and outbreaks. Increasing vaccination coverage among persons with risk factors for hepatitis A infection is important, including among those who use drugs. This report describes the initial outbreak and the ongoing community transmission of HAV. The initial outbreak and community transmission have exceeded US$3 million in estimated direct costs ( 4, 5). As of September 30, 2022, * an additional 98 cases had been reported to RCAHD. After the outbreak, the community experienced ongoing person-to-person transmission of HAV, predominantly among persons who use injection drugs. ![]() The outbreak, which resulted in 51 cases, 31 hospitalizations, and three deaths, was associated with a food handler who was infected. In September 2021, the Roanoke City and Alleghany Health Districts (RCAHD) in southwestern Virginia investigated an outbreak of hepatitis A. As of September 2022, 13 states were experiencing outbreaks, including Virginia ( 3). After years of historically low rates of hepatitis A in the United States, the incidence began increasing in 2016, with outbreaks characterized by person-to-person HAV transmission among persons who use drugs, persons experiencing homelessness, and men who have sex with men ( 2, 3). Hepatitis A is a vaccine-preventable liver infection caused by the hepatitis A virus (HAV) it is transmitted through ingestion of food or drink that has been contaminated by small amounts of infected stool, or through direct contact, including sexual contact, with a person who is infected ( 1). ![]()
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