May 08, 2018
2 min read

Hepatitis A cases spike among drug users, homeless

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Since November 2017, Kentucky has seen a spike in reported hepatitis A cases, which has led to higher than average mortality rates among people with prior health conditions, including people who use drugs, according to the CDC.

“Although rare, hepatitis A can cause death in some people — such as people over 50 and people with other liver diseases,” the CDC told Infectious Disease News.

Although the all-age mortality rate for hepatitis A is 0.6%, a higher burden has been observed among the homeless population and among those who use injection and noninjection drugs in the state.

According to the Kentucky Department for Public Health, there have been 448 cases of hepatitis A, with 315 hospitalizations and four deaths since November 2017. Some of the cases identified in Kentucky have been linked through viral sequencing to the outbreaks that occurred in California and Utah.

Indiana has also observed an increase in hepatitis A cases, particularly among injection drug users, since November 2017. Currently, Indiana has 91 reported hepatitis A cases, with 44 hospitalizations and no deaths. On average, the state observes approximately 20 hepatitis cases a year. Indiana health officials said the spike in hepatitis A cases in southern Indiana may be linked to the Louisville, Kentucky, outbreak.

Since 1995, the contagious liver infection has been a vaccine-preventable disease, and the national CDC hepatitis A guidelines recommend that children aged younger than 1 year, among other at-risk groups, receive the vaccination. However, the CDC has not issued a specific recommendation for hepatitis A vaccination among all adults living in Kentucky or Indiana.

“State and local health departments in the affected areas are prioritizing vaccination to individuals at highest risk of acquiring infection, including injection/noninjection drug users, men who have sex with men, persons in transient living conditions, recently incarcerated persons and individuals with chronic liver disease,” the CDC told Infectious Disease News.

According to a press release issued by the Louisville Metro Office of Public Health and Wellness, a White Castle employee has been diagnosed with hepatitis A. Anyone who ate at the establishment located at 3701 Seventh St. Road in Louisville between April 6 and April 20, may have been exposed to the hepatitis A virus.

Working in conjunction with the University of Louisville Global Health Center, the Louisville Metro Office of Public Health and Wellness is providing vaccines to people who work in hospitality at a reduced cost of $25, according to the release.

“As soon as we became aware [of the hepatitis A exposure], we worked with the health department and did offer vaccines to all of our team members in the Louisville region,” Jamie Richardson, vice president of White Castle told Infectious Disease News. “As a family-owned business, our number one priority is the safety of our team members and of our guests.”


CDC. 2017 – Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs. Accessed May 7, 2018.

Kentucky Department for Public Health. Accessed May 7, 2018.

Indiana Public Health. Indiana hepatitis A outbreak. Accessed May 7, 2018. White Castle employee diagnosed with Hepatitis A virus. Accessed May 7, 2018.

Disclosure: Richardson is the vice president of White Castle.