Hep A Shot

As Franklin County continues to lead the state in hepatitis A cases the frequency of new cases being reported is beginning to slow.

During the early summer, the county health department was reporting between five and eight new cases each week, with the high-water mark being 11 cases in one seven-day period.

The weekly numbers are now down to just one or two weekly as more and more vaccines are administered.  

As of Thursday, Franklin County is reporting 71 confirmed hepatitis A cases and one potential here since Jan. 1.

Two months ago, on July 1, the total cases numbered only 30.

Before this year, Franklin County had not had any reported hepatitis A cases in the past decade.

Franklin County Presiding Commissioner Tim Brinker told The Missourian the county health department has administered 3,008 hepatitis A vaccines since the beginning of the outbreak in January.

The number of vaccines given this year already surpasses any year-end total since the county started tracking in 2007. 

After an employee of Bob Evans in Washington was diagnosed with the virus in early August, the restaurant chain offered to pay for mass vaccinations for patrons who may have eaten there while the employee was working.

During that two-week period, hundreds more people were vaccinated at the Walgreens and CVS pharmacies in Washington.

Two other restaurants in Franklin County also had employees diagnosed with the virus this summer, which prompted the county commission to pass a regulation that all employees at the more than 500 food service establishments be vaccinated for hepatitis A.

In the St. Louis area, only St. Louis County required a hepatitis A vaccine for food workers. St. Charles and Jefferson counties do not require hepatitis A vaccines.

Although there has been only one case in the two- year reporting period, the Warren County Commission has passed an order requiring food service workers to be vaccinated for hepatitis A.  

The order states that by Nov. 20, any person who prepares or handles food for public consumption, or works in areas where that food is served, must be vaccinated for hepatitis A. This includes all restaurants, school kitchens, food carts and caterers anywhere in Warren County.

After Nov. 20, new food service employees must be vaccinated within two weeks of being hired.


From Sept. 15, 2017, to Aug. 27, 2019, there have been 424 hepatitis A outbreak-associated cases in 35 Missouri counties. 

Of the cases reported, there have been 237 hepatitis A outbreak-associated hospitalizations and 2 hepatitis A outbreak-associated deaths. 

Local public health agencies across Missouri are working to vaccinate at-risk populations to help stop the outbreak. 

Missouri Department of Health and Senior Services (DHSS) Director Dr. Randall Williams recently accompanied members of the Section for Disease Prevention to the National Viral Hepatitis Planning Meeting in Atlanta to glean information from other states.

“One notable state we heard from was Tennessee, a state comparable in size to Missouri, which is experiencing an even more severe outbreak,” Williams said. “We are grateful to have their insight and perspective on this issue. Their experience has allowed us to be more prepared for this potential situation and work to prevent this type of contagious outbreak to spread further.” 

Vaccines for Kids

Other states and counties in Missouri, which have battled the hepatitis A virus, have found that vaccinating as many people as possible will stop the spread over time.

The hepatitis A vaccine is a two-dose vaccination. However, the first dose of hepatitis A provides 95 percent protection for up to 11 years for healthy adults.

Now, the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) recommends that all children and adolescents aged 2 through 18 years who have not received a hepatitis A vaccine be vaccinated.

Funded by the CDC, the Vaccines for Children (VFC) program provides vaccines at no cost for children before their 19th birthday or younger who meet the following criteria:

• Medicaid eligible;

• Do not have health insurance;

• Are American Indian or Alaskan Native; or

• Are underinsured


As the outbreak has progressed throughout the summer in Franklin County, much has been made about the ties between illicit drug use and transmission of the virus.

Although IV drug users are at the top of the at-risk groups, the virus itself is not spread through shared needles.

The disease appears to be spreading through direct person-to-person contact, mostly among people who use illicit injection or noninjection drugs and their close contacts.

According to the DHSS, hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool (poop) from an infected person.

Hepatitis A is a viral infection of the liver that can cause loss of appetite, nausea, tiredness, fever, stomach pain, brown-colored urine, and light colored stools. Yellowing of the skin or eyes might also occur. 

However, only about 30 percent of infected children under the age of 6 have symptoms and few will have jaundice. People can become ill up to seven weeks after being exposed to the virus.

In addition to vaccination, careful hand-washing with soap and water, including under the fingernails, after using the bathroom or changing diapers and before preparing or eating food can help prevent the spread of this disease.