Hepatitis A outbreak infects 14 in Nashville; vaccines advised for gay men, drug users

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Fourteen people have contracted hepatitis A in Nashville in the last six months, causing the Metro Public Health Department to offer free vaccinations for illicit drug users, gay and bisexual men and the homeless population.

Health officials announced the outbreak on Friday afternoon and said vaccinations will begin Tuesday. Vaccines can be obtained at three public health centers:

East Health Center at 1015 East Trinity Lane

Lentz Health Center at 2500 Charlotte Ave.

And Woodbine Health Center at 224 Oriel Ave.

Despite the push for vaccinations, it is unlikely that Metro Health has enough. The department currently has only about 1,150 vaccine doses, according to an agency email obtained by The Tennessean. Neighborhood Health, a clinic network that will help give out the Metro Health vaccines, said the current supply will cover "less than 5 percent of the at-risk population."

“Neighborhood Health alone cares for over 5,000 homeless people in Nashville. We know there are over 18,000 (gay and bisexual men). And we have an unknown number of drug users,” said Brian Haile, Neighborhood Health CEO. “It is of utmost urgency that we work together to fund and find an adequate supply of vaccine for those at risk.”

Neighborhood Health will also administer vaccines at three locations:

The Downtown Clinic at 526 8th Ave. South

Madison Clinic at 601 W. Due West Ave.

My House Clinic at 442 Metroplex Drive, Building D, Suite 200.

Brian Todd, a spokesman for Metro Health, said the department is prioritizing getting more vaccines. Todd said that if an at-risk person has insurance, Metro Health will encourage them to see their doctor because some private health care providers also carry the vaccine.

OUTBREAK: There is a big hepatitis A outbreak in Kentucky. Here is what you can learn from it.

Although the outbreak was not announced to the public until Friday afternoon, most of the medical community was told Thursday to prepare. Dr. Bill Paul, the Metro Health director, sent a mass email Thursday, urging a coordinated response.

'We anticipate that this outbreak will get bigger'

“We are early in this response, but based on what we know about hepatitis A and the initial cases, we anticipate that this outbreak will get bigger and require a vigorous response over many months by many organizations,” Paul wrote in his email.

Paul added that Metro Health will prioritize vaccination of drug users and gay and bisexual men because 12 of the 14 known cases appear to be connected and all come from groups of drug users or men who have sex with other men. Some of Metro Health's limited vaccine supply will be sent to public STD clinics and drug treatment facilities because they are both in close contact with these groups.

None of the current outbreak patients are homeless, but the infection is likely to spread through that population anyway.

“Based on what has been seen nationally, the homeless population is especially vulnerable,” Paul wrote. “We expect that a more comprehensive, multi-agency outreach effort will be necessary to have a significant protective impact for the homeless. We are now planning that type of campaign and we will also need to identify funding to support it.”

Hepatitis A is a vaccine-preventable liver disease caused by a virus, according to a health department press release. Common symptoms include: fever, nausea, vomiting, abdominal pain, dark urine, jaundice (yellowing of eyes and skin), and clay-colored stools. Most people recover in a few weeks, but the disease can be severe in some people and require hospitalization. A recent outbreak in Kentucky has spread to more than 440 people and killed 4.

Hepetitis A is usually spread when a person unknowingly ingests the virus through food or drink that is contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person, such as through sex or caring for someone who is ill.