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Growing Hepatitis A outbreak won’t slow soon, Florida surgeon general warns

Florida’s ongoing hepatitis A epidemic has already far eclipsed state records, but people shouldn’t expect the outbreak to end anytime soon, the state’s surgeon general says.

Scott Rivkees, the newly installed head of the state’s Department of Health, told lawmakers Tuesday that 3,009 cases of the virus have been reported this year as of September 7, and that the state is still working to vaccinate hundreds of thousands of high-risk or medically vulnerable patients to curb the virus’ spread.

Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018 — but it is unclear what fraction of those vaccinated are part of the high-risk population that federal officials recommend should be 80% vaccinated to curtail an outbreak. At least 83,733 people deemed at “high risk” have been vaccinated by county health departments since the beginning of 2018, according to the state Department of Health.

There are about 491,000 people deemed high-risk in Florida, referring to people who use recreational drugs or are homeless. An additional 838,500 people are considered medically vulnerable — with an underlying liver disease or who are over 60 with a chronic medical condition.

“It’s going to take us a while” before the outbreak ends, Rivkees told the Senate Health Policy committee. He added Floridians should remain vigilant about getting vaccinated and practicing good hygiene.

Hepatitis A, a highly contagious virus that can cause liver damage, is passed from person to person in several ways, from eating or drinking food or water contaminated with fecal matter with the virus or through sex. Symptoms include fever, fatigue, gastric issues, nausea, darker urine and jaundice.

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Cases for the prior five years have hovered in the hundreds, but this year shot above 3,000 by early September, fueled in part by a national rise of cases that have traveled across state lines from the Appalachian region, Rivkees said. Public health experts have linked the outbreak to the opioid crisis in that region, he added.

More than 25,000 cases have been reported across the country. In Florida alone, more than 2,300 people have been hospitalized this year with the virus and 40 have died. Florida’s cases are concentrated in a central band of the state, though nearly every county in the state has had at least one case this year.

The state declared a public health emergency on August 1 for all counties, with a focus on 17 “critical” counties stretching from Pinellas and Pasco counties to Brevard and Volusia counties. The state has received reports of several cases of hepatitis A in food service workers, but Rivkees said so far the state does not know of any cases of transmission to diners.

Rivkees said the state is working with county health departments to provide free and low-cost vaccines to people who are uninsured or under-insured. He added those county departments are working with local organizations like homeless coalitions and jails, where he said people are more likely to have used drugs, to vaccinate people who might be at higher risk.

Federal officials have also provided more resources and vaccine doses to help Florida curb the epidemic, he said.

Committee chair Sen. Gayle Harrell, R-Stuart, said that Rivkees also sought to have vaccines available at hurricane shelters opened for Hurricane Dorian earlier this month to reach more people, an approach she praised.

According to the state Department of Health, the federal Centers for Disease Control and Prevention have advised that about 80% of people deemed high-risk — about 392,000 people in Florida — need to receive the vaccine to significantly slow an outbreak’s spread. County health departments have vaccinated at least 20 percent of that “high risk” population since 2018, though the state Department of Health does not have numbers for how many additional people who meet that criteria have been vaccinated by other providers.

Rivkees did not answer questions Tuesday when he left the meeting.

Rivkees, who officially started his job this summer, has yet to be confirmed by the Senate. When sexual harassment accusations arose shortly after his nomination this spring, Senate President Bill Galvano, R-Bradenton, said the chamber would delay confirmation hearings for Rivkees until the 2020 session. Rivkees, in an unusual arrangement, is also maintaining his tenured post as a University of Florida professor while taking on his job as surgeon general.

That prompted Sen. Darryl Rouson, D-St. Petersburg, to question Rivkees’ “attention paid to the public health emergency” while he splits his time between Gainesville and Tallahassee.

But before Rivkees could answer, that question was quickly shot down by Harrell, who said such questions should be saved for a future confirmation hearing.

“The question screams in my mind,” Rouson responded. “I would be remiss not to address it.”

This story has been updated.