Hep A Syringe

Despite the last new hepatitis A case being reported in Franklin County on Oct. 11, the outbreak is still not classified as over.

That classification can only be made when an area goes through two incubation periods or 100 days without a new case.

Franklin County Health Department Director Angie Hittson confirmed there have been 53 male cases and 28 female cases already diagnosed in the county this year, and despite the lull, more cases may still be diagnosed.

“I don’t know that I would call it a flare-up, but yes I do anticipate ongoing cases,” Hittson said. “We know that many in the high-risk groups move around frequently, which increases the chance of ongoing spread. While I do not anticipate a huge influx of cases, that can change at any time depending on who becomes ill, what their symptoms are and how many they expose.”

Hittson said as of last Oct. 18, the health department staff has given a total of 4,139 hepatitis A vaccines and many doctor offices, pharmacies and take care clinics saw an increase in the amount of vaccines given, but the health department does not have that data.

Many of these vaccinations came as a result of three restaurants being closed down temporarily due to employees being diagnosed with the virus and requiring all other employees at the establishments to be vaccinated.

Franklin County held special free vaccination clinics to vaccinate customers who had eaten at the restaurants where a confirmed employee diagnosis had occurred.

Because of the potential threat of the virus spreading through food service workers, in late July, the county commission passed an order mandating all food service workers at roughly 500 establishments be vaccinated.

“Hundreds have already complied,” Hittson said. “We haven’t started inspections to ensure everyone has yet. Our numbers show that we have provided immunizations to over 4,000 people. “We do not tally how many of those are from businesses, but I know we have provided immunizations for many that needed it for work,” she noted.

Hittson added the department is not seeing the spread of this into St. Louis, perhaps because so many have been vaccinated over the years due to work requirements


Although the thousands of vaccines administered have led to the slowing of the outbreak, there are many other factors which have contributed as well, including “early, complete and follow-up disease case investigation,” Hittson said.

“We do not delay starting disease case investigations,” she said. “Our local medical providers and hospitals are great about reporting communicable diseases. Once we obtain notification of a new case it is started very quickly so we can determine the source and stop the spread of the disease.”

Hittson added with this outbreak, staff went on-site to the hospital or to the home to interview patients if they could not reach them by phone.

“We did not close cases without investigating them,” she said. “Our staff really went above and beyond to not only locate and investigate the cases, but to develop a trusting relationship. This trust provided us with the opportunity to get accurate information to determine the source. It also connected us to other ill cases that were not diagnosed because they refused to seek out health care.”

Early identification and quick immunizations of close contacts were key.

“This often meant multiple reminder phone calls, sometimes going off-site to do immunizations, working extra hours and overbooking of our schedule, but we knew this was important so we really focused on getting it done,” Hittson said.

Media reporting allowed increased awareness and getting information out to large groups of citizens at once.

“Media certainly drove attention to the issue, which is great for education and mass vaccination efforts,” Hittson said. “The unfortunate side of it is that many times the media was so relentless and aggressive in their efforts to get information that it slowed us down and pulled us away from doing the work we needed to do.”


Hittson praised the passion and work ethic of health department staff, including clerical, nursing, WIC, environmental, planning and epidemiologists, all of whom worked long hours under quite a bit of stress.

“Between news cameras that refused to leave the lobby, phones that rang constantly, frequent scheduling conflicts and moving clients, short staffing, angry clients, working outside of their job description/comfort zone, working weekends, working in environments that are not comfortable to them, this staff went above and beyond their job duties to protect the citizens,” she said. “At best, we had 12 to 13 employees on any given day to fulfill all required jobs, plus respond to the outbreak. I am really very proud of what we were able to do.”


Hittson says she is unable to answer what the hepatitis A outbreak this summer has cost Franklin County. The financial toll will likely not be known until the end of the year.

“Due to contract requirements, pending payments and other obligations, I will not have time to analyze this the way I need to until things slow down,” she said. “Between staffing issues, catching up from the outbreak and flu season, there are just not enough hours in the day.”

The outbreak was the biggest priority and took up the bulk of disease case investigation staff time, nursing staff time and front desk clerical time during the summer, she said.

“We are all still trying to get caught up on work that is required from the contracts and grants that fund us,” Hittson said. “I have three staff that are salary. I can tell you all three of us have worked an intense amount of overtime this year.”


As of Oct. 15, there have been 488 cases of hepatitis A reported in Missouri since the virus first reemerged two years ago.

The county with the most cases since that time was Butler County, with 108, followed by Franklin County with 79.

The next closest is Howell County, with 50 cases.

The main difference is that all of Franklin County’s cases have come in 2019.

Before January, the last reported case of hepatitis A in Franklin County was 10 years ago.

In the past two years, 278 people have been hospitalized for hepatitis A statewide and two have died.