When it comes to hepatitis A, Spokane isn’t that special.
The county is like Des Moines, Detroit or even northwest Arkansas, which all have outbreaks of the virus. It’s nothing like California, which accounts for one-fourth of the hepatitis A cases in the country.
Dr. Fred Shaw, who’s studied the virus since 1983, gave a Hepatitis 101 class Wednesday afternoon to about 100 people at the Spokane Regional Health District.
“Hepatitis A is a disease of behavior and a disease of socioeconomics,” Shaw explained.
The virus has been tied to methamphetamine users, particularly in adult outbreaks such as the one in Spokane. Shaw suspects that’s because drug users tend to have poor hygiene. The virus is spread by fecal-oral contact.
About 17 percent of the 136 people who have tested positive for hepatitis A in Spokane County this year have admitted to using intravenous drugs.
Shaw tried to explain the outbreak and how Spokane fits into the national picture.
About half the people in the audience worked for the health district. The rest were community members concerned about hepatitis A, including a nurse from Sacred Heart Medical Center, a doctor who wanted to know who to vaccinate, and the incoming president of the Washington state Restaurant Association.
Dr. Kim Thorburn, district health officer, reviewed the Spokane outbreak and the district’s response.
Thorburn last week advised county residents to consider getting vaccinated against the disease. Since then, about 700 people have been vaccinated. People may be waiting for the vaccine price to drop before getting the shots, Thorburn said.
A new federal contract drops the cost to $26 for each of two shots. But the district must use up about 800 of the more expensive doses, which cost $42 each, before receiving the less expensive ones, Thorburn said.
Dr. Paul Stehr-Green, the state’s chief epidemiologist who questioned Thorburn’s vaccination call last week, was supposed to speak at Wednesday’s meeting. But he didn’t attend because he was sick, Thorburn said.
Shaw said a call for voluntary vaccinations during a hepatitis A epidemic isn’t that unusual.
He started studying the disease at the Centers for Disease Control and Prevention in Atlanta because he was the low man in the department. Hepatitis A wasn’t that interesting, he said, until a vaccine came along.
Two vaccines have been available since 1995. Shaw’s trip to Spokane was paid for by one of the drug companies that makes the vaccine, Smith-Kline Beecham. He is a consultant for that company.
Hepatitis A is rarely fatal, but people can get very ill, feeling sick for 1-1/2 months or more. Adults miss an average of 27 days of work. Each person sick with hepatitis A costs from $1,800 to $2,500 in medical bills and loss of work time.
Shaw talked about targeting vaccinations, particularly in schoolchildren. Schools in Oklahoma are now vaccinating all children against hepatitis A. So are some schools in Salt Lake City, El Paso and San Antonio.
Thorburn has proposed starting a vaccination program in Spokane County elementary schools.
But that doesn’t target drug users, who are susceptible to the outbreak and hard to reach. Getting drug users back for a second shot six to 12 months later is even more difficult.
Thorburn is still pushing to vaccinate inmates in jail, which she believes would target drug users. The state Legislature included $300,000 in emergency money for communities such as Spokane for vaccinations. If the money stays in the budget, Thorburn plans to apply for it to vaccinate willing jail inmates.
Thorburn also said that almost 200 restaurants and all grocery stores have vaccinated their workers. And the district’s hand-washing campaign has reached hundreds of people from Head Start students to the homeless.
Thorburn stressed that her call for hepatitis A vaccinations last week was voluntary.
The move attracted national attention and questions from other publichealth professionals.
“This is a voluntary vaccination call,” she said. “It is not meant to stop the epidemic. … It’s safe, it’s effective, it is a way you can protect yourself.”
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MEMO: This sidebar appeared with the story: The disease Hepatitis A is rarely fatal, but people can get very ill, feeling sick for 1 months or more. Adults miss an average of 27 days of work. Each person sick with hepatitis A costs from $1,800 to $2,500 in medical bills and loss of work time.