Volume 4, Number 1
Number of hepatitis A cases by month Spokane County |
(Spokane, Washington) The intense hepatitis A outbreak that has affected Spokane since 1997 is over, according to Dr. Kim M. Thorburn, Spokane's health officer. Spokane's hepatitis A incidence rate peaked at about 130 per 100,000 person-years in January 1998, over 10 times the average U.S. rate (see graphic). The outbreak was centered mainly in adults, with a preponderance of cases in males and drug abusers, particularly abusers of methamphetamine (for a review of the outbreak, see Hepatitis Control Report, Winter 1997-98 issue).
Early in the epidemic, Thorburn adopted aggressive vaccination recommendations for drug abusers, and later, for children in the general population. Spokane vaccinated over 30,000 people, including about 5,000 high-risk inmates in local jails, making it one of the nation's largest outbreak intervention programs. Thorburn also recommended vaccination of foodhandlers after infected workers in several restaurants prompted mass administration of immune globulin. Several major food outlets began vaccinating all foodhandlers.
Thorburn estimated the cost of the vaccination program so far at over $1 million. It was financed through a special $300,000 state appropriation, plus county and federal funding through the Vaccines for Children entitlement. Thorburn and her colleagues are now completing an analysis of the outbreak.
Washington is one of the states included within ACIP's recent recommendation to vaccinate children routinely. Following the Spokane outbreak and in response to ACIP, the state is now considering a broader, more proactive vaccination policy.