Hepatitis A outbreak feared

Case identified in Nashua

Courtesy photo from Centers for Disease Control and Prevention The viral disease hepatitis A, is manifested here, in a symptom known as icterus, or jaundice of the conjunctivae and facial skin. This involves the yellow coloration imparted to these areas due to a the deposition of pigment, which builds up as a result of bile duct obstruction.

NASHUA – Yellowing of the skin and eyes, nausea and vomiting are some symptoms those infected with hepatitis A are experiencing as the virus spreads across Southern New Hampshire.

Tuesday, officials with the New Hampshire Department of Health and Human Services said they have identified 13 individuals diagnosed with hepatitis A during the last three months, including five in Hillsborough County – and one in the city of Nashua.

By comparison, New Hampshire’s statewide total number of hepatitis A cases for a typical year is only seven.

“The problem is, when it gets into a community, even folks not considered in those high-risk populations, it can spread,” Flavia Martin, public health nurse at Nashua’s Division of Public Health & Community Services, said.

“It can spread to those without any of those specific risk factors,” she added.

Martin said there was one report of a hepatitis A diagnosis received and investigated by her office in December. She said the other four cases within Hillsborough County were not in Nashua.

The Virus

The hepatitis A virus (HAV) is contagious and is transmitted when a person ingests it from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person. The virus can survive for months on surfaces.

“There are large outbreaks of hepatitis A occurring in multiple other states across the country,” New Hampshire State Epidemiologist Dr. Benjamin Chan said. “While these outbreaks have often started in individuals experiencing homelessness and those with a substance use disorder, once it is in our communities, it can spread very easily even to others without specific risk factors.”

State officials said people at higher than average risk of contracting the virus are those who are:

experiencing homelessness;

using injection or non-injection recreational drugs, including marijuana;

experiencing homelessness or with unstable housing;

gay or bisexual;

ongoing, close contact with individuals who use injection and non-injection drugs, or with individuals experiencing homelessness;

close contacts of individuals diagnosed with hepatitis A; and

travelers to countries with high rates of the virus.

The virus causes inflammation of the liver. Severe infections can result in liver failure and even death.

Other symptoms of possible infection include fever, tiredness, loss of appetite, abdominal pain, dark urine, clay-colored bowel movements and joint pain.


“Thankfully, hepatitis A is a vaccine-preventable disease. We encourage anybody who wishes to protect themselves from hepatitis A to talk with their health care provider about obtaining the very effective hepatitis A vaccine,” Chan said.

Since September, Nashua city officials have been doing some outreach activity, specifically targeting high-risk populations by doing vaccinations. Martin said her division is still going strong with their outreach activities and are reaching out to area shelters, the Nashua Soup Kitchen & Shelter and the Nashua Public Library.

She said they are at NSKS every third Monday, and will be there from 11 a.m. to 1 p.m. Feb. 25. They will be at the NPL every second and fourth Wednesday of the month from 9-11 a.m.

Martin said other times and locations are often listed on the website at, https://nashuanh.gov/497/Public-Health-Community-Services.

Vaccines are also offered at the city’s Walk-In Clinic at the division at 18 Mulberry St. from 4-7 p.m. Tuesdays, 3-6 p.m. Thursdays, and 8:30-10:30 a.m. Fridays. The vaccines are offered for free or at a reduced rate.

Martin said the vaccine is done in a two-dose series, with the first dose providing about 95 percent coverage. The second dose comes six months after the first one, and bounces the person up to nearly 100 percent coverage. She said the vaccine is very safe and effective, and is the best protection there is. She said the best way to prevent infection is to get vaccinated.

Since September, public health nurses have accompanied outreach workers as they go to homeless encampments and places where those in high-risk populations are known to congregate. Additionally, she said hygiene is a major factor, and encourages people to wash their hands.

More information on hepatitis A is available online at, https://www.dhhs.nh.gov/dphs/cdcs/hepatitisa/index.htm.