Dr. Jennifer Mullendore is the Medical Director at the Buncombe County Department of Health and Human Services. Below is a copy of her recent written remarks to public health professionals in the WNC area. For more information about Hepatitis A, contact BCHHS at (828) 250-6308 or WNCAP at (828) 252-7489.
Hepatitis A outbreaks, involving person-to-person transmission, have been expanding in several US states over the last two years. Cases have occurred primarily among three risk groups:
(1) Persons who use injection or non-injection drugs;
(2) persons experiencing homelessness; and
(3) men who have sex with men.
Although North Carolina has not experienced an outbreak of the same magnitude as these states, an increased number of hepatitis A cases have been reported in the Charlotte area since April 2018, primarily affecting men who have sex with men. BCHHS is concerned that our community is at risk of an outbreak of hepatitis A because we have significant populations of all three of the aforementioned risk groups. While we are working on taking vaccine off-site to administer to high-risk populations in the community, we also want to engage your assistance in preventing a hepatitis A outbreak.
What can you do to protect high-risk patients and prevent an outbreak of hepatitis A?
- Increase hepatitis A vaccinations among the following groups:
- Persons who use injection and non-injection drugs;
- Persons who are homeless;
- Men who have sex with men; and
- Persons with a chronic liver disease, including chronic hepatitis B or C.
**Any uninsured adult who falls into one of the above groups can receive a three-dose series of the combination hepatitis A/hepatitis B vaccine for free at any NC local health department (including BCHHS), federally-qualified health center, or rural health clinic.
**BCHHS Immunization Clinic also participates in pharmaceutical company vaccine patient assistance programs and will work with patients to get them the monovalent hepatitis A vaccine if for some reason they do not qualify for the combination hepatitis A/hepatitis B vaccine.
- BCHHS Immunization Clinic is located on the ground floor at 53 S. French Broad Ave., Asheville and is open M-F from 8:00 am-5:00 pm (we ask that patients check-in by 4:30 pm).
- Vaccinate others for whom hepatitis A vaccine is routinely recommended, including all children (beginning at 1 year of age), persons at increased risk for infection with or complications of hepatitis A, and any other person wishing to obtain immunity.
- Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms.
- If hepatitis A is suspected in a person in one of the 3 primary risk groups listed above, please collect and hold at your lab an extra red top tube of blood that may be submitted to the North Carolina State Laboratory of Public Health for confirmation and possible genotype testing at the CDC if the initial hepatitis A IgM result is positive. Please notify the Communicable Disease Branch epidemiologist on call (919-733-3419) of specimens that meet these criteria.
- Do not test people for hepatitis A unless they have signs of acute hepatitis. False-positive IgM results can occur in persons without acute clinical hepatitis illness, especially in the elderly.
NC law requires physicians to report suspected cases of hepatitis A to their local health department within 24 hours. You can contact Buncombe County Communicable Disease Control staff at 828-250-5109 (available 24/7/365).
Please see the attached memo from the NC Division of Public Health for more details on the outbreaks. Additional information on hepatitis A can be found on the CDC website at https://www.cdc.gov/hepatitis/hav/index.htm.Please let me or the BCHHS Communicable Disease Control staff know if you have any questions or concerns about this information.
Thank you for the care you provide to our community.
Jennifer Mullendore, MD, MSPH
Buncombe County Health and Human Services
Office: (828) 250-6308