SCOTT HEPATITIS OUTBREAK SPREADS TO 55

Sue Tippen is keeping her fingers crossed that an immunization campaign has contained a hepatitis A outbreak in the Sikeston area.

Tippen, the communicable disease coordinator for the Missouri Department of Health in Southeast Missouri, said no new cases of the disease, which is a viral liver infection, have been reported in eight days.

So far 55 people in Scott, New Madrid and Stoddard counties have been diagnosed with hepatitis A in the Sikeston outbreak. The source of the outbreak is still unknown, Tippen said, but the earliest diagnosed cases have been traced to four children in Scott County.

Children don't always show symptoms of hepatitis A, and may go undiagnosed, although they are "very efficient transmitters" of the disease, she said.

The four siblings were diagnosed by accident, Tippen said. "They were only diagnosed because we started asking questions of the infected cases we had."

The children's mother was diagnosed with hepatitis A, and told health workers that her children reported "not feeling well." But since they didn't show symptoms of the disease, she didn't worry about it.

"But about 30 days later, mom started feeling really bad," Tippen said.

Vaccination clinics were held for the public and for food handlers in the Sikeston area, and those clinics may have stopped the outbreak from getting worse, she said.

"In Scott County, what we were dealing with was trying to stop an outbreak," Tippen said. "We knew that if we didn't get a barrier there somewhere, we were going to end up with an infected food handler."

No food handlers have been diagnosed with hepatitis A in the Sikeston region, she said, and she's hopeful none will be as the outbreak apparently winds down.

"Give me another 60 days and I'll say we're out of the woods on food handlers," Tippen said.

Hepatitis A vaccine is usually used as a preventive measure, she said, but in the Sikeston outbreak it was used as an intervention.

"We had no choice," she said.

The Cape Girardeau County Public Health Center held a hepatitis A vaccination clinic last week for food handlers and the public.

No cases related to the Sikeston outbreak have been identified in Cape Girardeau County. Only one hepatitis A case was identified in Cape Girardeau County last year, and no food handlers have been infected with the disease in Cape Girardeau County.

The initial case in the Sikeston outbreak has not yet been identified, Tippen said, adding she hopes to be able to graph the spread of the disease as more information becomes available.

Tracing outbreaks of hepatitis A and other infectious diseases takes detective work, Tippen said Tuesday night at a community forum on hepatitis A.

Public health workers have to find out where the person infected has eaten, if the disease is food-borne, who they have come in contact with, what they do for a living and other details.

Hepatitis A is a viral infection of the liver, and is spread through contaminated food and water and person-to-person contact.

Good hygiene is paramount in stopping the spread of the disease, Tippen said, and hand-washing is crucial because the disease is present in fecal matter.

One problem with stemming hepatitis A outbreaks is the disease has a long incubation period, she said.

A person may not develop the disease for 15 to 50 days after being exposed to the virus, and it is hard for people to remember all the contacts they have had in that timeframe.

"That's one of the problems that we face in trying to determine the source of an illness or the source of an outbreak," Tippen said.

The symptoms may last from one and a half to two weeks, and a person may remain infectious for up to two weeks after symptoms begin.

Hepatitis A is seldom fatal, but full recovery can take several months. In very rare cases, the liver damage has been severe enough to require transplants, Tippen said.