Hepatitis outbreak in county studied 19 cases reported in January

alert issued statewide

March 18, 1998|By Dail Willis | Dail Willis,SUN STAFF

Baltimore County had 19 cases of hepatitis A in January -- one more than the 18 cases reported by the county for all of 1997 -- and Maryland health officials said yesterday they have issued a statewide alert while they investigate the sudden spread of the illness.

The January outbreak was clustered along the York Road corridor from the city line into northeastern Baltimore County, according to state health officials. But the cause, and why it is concentrated in that area, remains unexplained.

"We are investigating an increase in hepatitis A in the Baltimore County-Baltimore City area," said Dave Portesi, an epidemiologist with the Maryland Department of Health and Mental Hygiene. "We have seen this cluster only in Baltimore County, nowhere else -- although we have seen a slight increase in Baltimore City."

Patients interviewed

Portesi said his agency was compiling figures for the city, as well as interviewing the 19 county patients in an effort to discover if the cases are linked. No single factor has emerged.

Nationally, between 23,000 and 35,000 people are diagnosed with the infectious liver disease every year, said Dr. Beth P. Bell, a medical epidemiologist with the hepatitis branch of the Atlanta-based Centers for Disease Control and Prevention.

"The majority of hepatitis A in this country is transmitted from person to person in family or extended-family settings," Bell said.

Hepatitis A is carried in human feces and often is a food-borne disease associated with poor hygiene, Portesi said. It can be spread by food service employees who don't wash their hands after a trip to the restroom, by babies and toddlers in day care centers or -- in rare cases -- shellfish. It also can be spread through sexual contact, and homosexual men are at particular risk, Portesi said.

Symptoms include jaundice, diarrhea, fever and diminished liver function.

"Hepatitis A is relatively minor, though it can still have serious complications," Portesi said.

Investigators in the Epidemiology and Disease Control Program in the state's health department have ruled out shellfish as a cause.

"If it was shellfish, we'd expect to see a lot more than 19 cases, and we'd expect to see it all over the state," Portesi said. "We have no definitive source. We have no idea where it's coming from."

Normal February

The increase came to the attention of Baltimore County health officials in early February, Portesi said. The county numbers dropped to normal for February and the first part of March, Portesi said: five cases in February, two this month.

Health officials from Baltimore, Baltimore County and the state met Monday to discuss the increase in cases, Portesi said.

"The investigation is still ongoing," said Dr. Michelle Leverett, director of the Baltimore County Department of Health.

Leverett and Portesi said that hepatitis A is classified as a "reportable disease," meaning that whenever it is diagnosed, doctors must report it to the state.

Those reports are filed directly with the state, which works with the county health department to determine cause and any action necessary to stop the spread of the illness.

Finding a link between cases is difficult. The monthlong incubation period means people are asked to remember actions and meals more than a month old.

"A large proportion of people don't know where they got it," Bell said.

Pub Date: 3/18/98

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