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HE A LTH • Winter 2019 7 CONVENIENT OUTPATIENT LOCATIONS in Massachusetts and Rhode Island AdCare.com Substance Use Treatment On Your Time. Call AdCare Outpatient at 1-800-ALCOHOL state's residents. The response has included the city's health office, hospitals and other health providers including the Edward M. Kennedy Community Health Center and the Family Health Center of Worcester vaccinating at-risk residents and spreading word of the importance of hand-washing after using the rest- Hepatitis A outbreak Massachusetts is one of 30 states that have declared a hepatitis A outbreak since 2016, and has the 11th most deaths in that time. States with outbreaks as ranked by number of deaths: Note: Percentage adds to more than 100 because of rounding. Data is as of Oct. 18. Source: Massachusetts Department of Public Health Kentucky ............................. 4,953 ................ 48% ............... 61 ................... August 2017 Florida .................................. 3,174 ................ 71% ............... 43 ..................January 2018 Michigan ................................. 920 ................ 80% ............... 30 ................... August 2016 West Virginia ....................... 2,577 ................ 50% ............... 23 .................... March 2018 Tennessee ........................... 2,652 ................ 61% ............... 21 ..............December 2017 California ................................ 708 ................ 66% ............... 21 ..............November 2016 Ohio ..................................... 3,359 ................ 61% ............... 16 ..................January 2018 Pennsylvania .......................... 630 ................ 77% ................. 9 ..................January 2018 Arizona ................................... 591 ................ 79% ................. 8 ..............November 2018 Georgia ................................... 745 ................ 68% ................. 7 .......................June 2018 MASSACHUSETTS ................ 522 ................ 79% ................. 7 ...................... April 2018 New Jersey ............................ 498 ................ 66% ................. 6 ..............December 2018 Indiana ................................. 2,190 ................ 55% ................. 4 ..............November 2017 Arkansas ................................ 433 ................ 52% ................. 3 ................ February 2018 Utah ........................................ 281 ................ 54% ................. 3 ....................... May 2017 Colorado ................................. 223 ................ 74% ................. 2 ................. October 2018 Missouri .................................. 492 ................ 57% ................. 2 ............ September 2017 New Hampshire ..................... 255 ................ 61% ................. 2 ..............November 2018 New Mexico ........................... 152 ................ 76% ................. 2 ..............November 2018 Illinois ..................................... 166 ................ 66% ................. 1 ............ September 2018 Louisiana ................................ 590 ................ 57% ................. 1 ..................January 2018 Nevada...................................... 98 ................ 87% ................. 1 ..............November 2018 North Carolina ......................... 96 ................ 67% ................. 1 ..................January 2018 South Carolina ....................... 531 ................ 62% ................. 1 ..............November 2018 Idaho ......................................... 63 ................ 49% ................. 0 ..................January 2019 Minnesota ................................ 41 ................ 71% ................. 0 ..............December 2018 Mississippi ............................... 60 ................ 65% ................. 0 ....................... April 2019 Virginia .................................... 215 ................ 62% ................. 0 ..................January 2019 Washington .............................. 96 ................ 53% ................. 0 ....................... April 2019 Alabama ...................................163 .............. 55% ............. N/A ............ September 2018 Percent State Total hospitalized Deaths Outbreak start Note: California and Utah have declared an end to their outbreak. Alabama did not report whether it had any deaths. Massachusetts data is through Oct. 18. Source: Centers for Disease Control and Prevention Hepatitis A cases by county Massachusetts is one of 30 states that have declared a hepatitis A outbreak since 2016, and has the 11th most deaths in that time. County Percent of cases Worcester ..........................................21% Suffolk ...............................................21% Middlesex ..........................................15% Essex .................................................13% Plymouth .............................................8% Hampden .............................................7% Norfolk .................................................7% Bristol ..................................................5% Barnstable ...........................................2% Hampshire ...........................................2% Berkshire .............................................1% Dukes ...................................................0% Franklin ............................................. <1% room and before eating. The city's health office has given 533 vaccinations since June 2018, largely at homeless shelters and human service agencies where they may be most likely to be found, Castiel said. The city started reaching out to hospitals and treatment centers to start the vaccination process after officials heard an outbreak was underway in Boston, she said. The Family Health Center is work- ing on electronic health record reports to idenify any remaining at-risk indi- viduals for any needed follow-up, and is continuing to screen patients in its substance abuse treatment program. Abraham estimates a peak in cases locally around six months ago, helped by both vaccinations and an awareness campaign. "We're trying to break the cycle, and I think we've had some success," Abraham said. Nationally, the CDC spent roughly $9.1 million in fiscal 2018 for nearly 160,000 vaccines. In Massachusetts, the Department of Public Health has distributed 14,770 doses of vaccines in an attempt to break the outbreak under control. They haven't gotten there quite yet. "We're still seeing three or four cases a week, so we still haven't got- ten to the end of this," Cranston said. One silver lining in the outbreak: hepatitis A is curable, and there's a vaccine that's easy to obtain. Symptoms include yellow eyes and skin, fever, and an upset stomach and diarrhea, and someone with the virus may feel sick for up to a few months. Most recover and don't have lasting liver damage, according to the CDC, but more than half of those affected nationally have been hospitalized. The Department of Public Health recommends anyone who thinks they may have hepatitis A to go to a doctor or the hospital right away, especially if they drink alcohol or already have a liver disease like hepatitis C. The Centers for Disease Control and Prevention recommends thorough hand- washing to avoid hepatitis A. A vaccination can be effective if given within two weeks of exposure, the CDC says. H

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