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Hep A map

The highest concentration of hepatitis A cases are in southeast Missouri, according to this map provided by the Missouri Department of Health and Senior Services.

ST. LOUIS — Missouri health officials warn that a hepatitis A outbreak in the state could get worse if it spreads to urban areas like St. Louis and St. Louis County and are urging at-risk populations to get vaccinated.

Since September 2017, the state has recorded 414 cases of hepatitis A in 35 counties, mostly in southeast Missouri, the Missouri Department of Health and Senior Services said Wednesday. The virus has sent 233 people to the hospital and caused two deaths.

Years prior, only about 10 cases were reported annually, said Dr. Randall Williams, DHSS director.

“Our concern is that right now, we are seeing it in more rural areas, and what one worries about is that when it gets into an urban area, it tends to accelerate” among high-risk populations such as illegal drug users and homeless, Williams said.

That has been the case in other states. Across the country, outbreaks of the virus have been reported in at least 29 states, according to a recent report by Kaiser Health News. It has sickened more than 23,600 people and killed more than 230.

Hepatitis A is a viral infection of the liver. It usually spreads when a person ingests the virus from objects, food or drinks contaminated by undetected amounts of stool from an infected person.

Symptoms include loss of appetite, nausea, tiredness, fever, stomach pain, brown-colored urine and light-colored stools. Yellowing of the skin or eyes might also occur. People can become ill up to seven weeks after being exposed to the virus.

Cases of the virus had dropped dramatically in the U.S. when a vaccine came out in 1995. As recently as 2015, only 1,400 cases were reported nationwide.

While many children were vaccinated, less than 10% of adults got the vaccines, according to Kaiser. With so many unprotected, numbers of cases started increasing dramatically three years ago.

Some states have declared a public health emergency over their rising numbers. Florida has had more than 2,000 cases since the beginning of the year compared with 548 all of last year.

Kentucky has had 4,793 cases since an outbreak there in 2017; since 2018, Ohio has had 3,220 and West Virginia 2,528, according to the Associated Press. In Kentucky, the virus has killed at least 60 people.

Williams said he recently attended a meeting in Atlanta where each state’s communicable disease experts discussed how they were responding to the outbreaks.

“One notable state we heard from was Tennessee — a state comparable in size to Missouri — which is experiencing an even more severe outbreak,” he said. “They very quickly developed a very robust and purposeful campaign to get people vaccinated.”

Williams said he is working with leaders of the St. Louis and St. Louis County health departments to plan outreach efforts to get high-risk populations vaccinated. Thorough hand-washing before eating or preparing food is also important.

He also wants to urge health providers to have the virus on their radar. “Three years ago, a provider might not be giving enough thought about hepatitis A,” he said. “We certainly want to raise their awareness and get vaccines for those people they are caring for.”

People in any of the following at-risk categories are urged to contact their local public health department with questions or requests to get vaccinated: recreational drug users, homeless persons, men having sex with men, people being treated for drug abuse, people who’ve been held in jail or a detention facility. People who have been in contact with at-risk individuals also are encouraged to contact local public health officials.