Kentucky has one of the worst outbreaks of hepatitis A in the country, and the liver disease has spread to several other Midwest states including Ohio, Tennessee and Indiana.
Since November, there have been more than 950 cases of hepatitis A in Kentucky, and six people have died. Indiana has had 148 cases in that same time, according to the most recent data from the Indiana State Department of Health. The Hoosier state typically sees 20 cases of the disease annually.
The cases have been found in seven Indiana counties and no one has died, but 63 people have been hospitalized because of the disease.
Hepatitis A spreads when a person ingests even a trace amount of fecal matter from someone who has the disease. There’s no treatment, but most people become immune after a few weeks.
Amelia Johns is a public health nurse for the Clark County Health Department. It’s her job to track down every person exposed to the virus in that county, which has had 56 documented cases, the most in Indiana.
Johns started paying attention to hepatitis A last November. She knew about the outbreak in Louisville, Kentucky, just across the Ohio River. A month later, a woman who was transferred from Louisville to the Clark County jail started to show symptoms: jaundice and vomiting. She had hepatitis A, and it soon spread to five others in the jail.
"In the jail, we’ve made some rules where we quarantine anybody that’s become positive," Johns said. "And if they’re symptomatic, we quarantine them."
This hepatitis A outbreak appears to be the ripple effect of drug use and homelessness. When the Centers for Disease Control and Prevention tested Kentucky’s first cases, they found the virus’s genetic characteristics matched cases in San Diego. That city also has had a large outbreak amongst its homeless population.
"They're out in the streets and we don't know exactly where they are staying," Johns said. "They may be staying in abandoned houses, they might be staying in camp locations across the county."
When Johns finds these people, she gives them hand sanitizer and offers vaccines to anyone they’ve come in contact with.
According to the Louisville Metro Department of Public Health and Wellness, 63.5 percent of the hepatitis A cases confirmed in Jefferson County, Kentucky were amoung people who use illicit drugs. Twenty-seven percent did not have stable housing and 3.3 percent were men who have sex with men.
The Indiana State Department of Health recommends anyone who has been exposed to the disease, who is homeless, who uses drugs or who has been incarcerated receive two doses of the hepatitis A vaccine.
This story was produced by Side Effects Public Media, a news collaborative covering public health.