Hepatitis A Cases Surge Overnight Supply Of Antidote Running Low

Spokane County’s hepatitis A outbreak shot up Friday to 53 confirmed cases since Jan. 1, and the supply of preventive medicine was nearly exhausted.

“Our number of cases is continuing to rise dramatically,” said Dr. Kim Thorburn, the county health officer. “That’s many times more than we usually see in a year.”

Friday’s total was up from 31 cases of the flu-like disease reported Thursday.

Thorburn said the Spokane Regional Health District administered more than 700 doses of immune globulin Friday to prevent the disease from developing in people who may have been exposed to it.

Health officials estimate that 13,000 to 20,000 people may have been exposed to the hepatitis A virus, based on customer counts at Players and Spectators restaurant in the Spokane Valley. Three workers at the restaurant contracted the illness, which is spread by failure to wash hands adequately after going to the bathroom.

About 2,000 restaurant workers and customers so far have received the $42 preventive shots. Those include all the workers at Players and Spectators and, as a precaution, all food handlers at Spokane hospitals.

The latest known potential exposure occurred Jan. 11, the final day on the job for the last of the restaurant workers who were diagnosed with hepatitis. Immune globulin must be taken within 14 days of exposure, so the last effective date for treatment of the known exposures is Jan. 25.

Thorburn said it is already too late for some of the people who were exposed earlier. They have been advised that, while hepatitis A affects the liver, it usually does not cause chronic problems and is rarely fatal.

There is no specific treatment once the disease is contracted, but Thorburn urged anyone who develops the flu-like symptoms to consult a doctor.

Meanwhile, supplies of immune globulin will run out next week.

Thorburn said Spokane has tapped all the available supply from other health districts in Washington and the state Health Department. She said the U.S. Centers for Disease Control and Prevention determined that neither the armed forces nor other states are willing to share any of their limited supply.

Fairchild Air Force Base hasn’t had any immune globulin in more than a year. Base spokeswoman Lt. Amy Haedt said Fairchild uses a new vaccine to protect base personnel before they are exposed. The vaccine doesn’t work fast enough to protect people who already have been exposed.

Thorburn estimated that only 1,400 doses of immune globulin will be left when the health district resumes giving shots Tuesday. That includes 150 doses the Spokane Veterans Affairs Hospital plans to share.

“Right now, there is not any available in the country,” said Patrick Schmidt, president of FFF Enterprises of Temecula, Calif., the sole U.S. distributor of immune globulin.

However, Schmidt said Bayer Biological Products has offered to supply another kind of immune globulin that ordinarily is used to treat tetanus. He said Bayer will sell the medication, called BayTet, at cost - which will make it half as expensive as regular immune globulin - but it would require two shots instead of one.

Thorburn said she’s pinning her hopes on the likelihood that the U.S. Food and Drug Administration will allow a Pennsylvania company to resume distribution of its immune globulin supply.

That company, Centeon, voluntarily stopped production 15 months ago to deal with manufacturing problems it was required to correct under a consent decree from the FDA. Among other things, the FDA found cracked manufacturing vials that could have caused contamination.

Several other factors contributed to the shortage, Schmidt and others said. He said a second manufacturer is waiting for an FDA license amendment before it can resume production, and a third supplier is having trouble getting the human blood plasma used to make immune globulin and similar protein-based medications.

FDA spokeswoman Lenore Geld said federal officials believe another factor in the shortage is physicians who prescribe immune globulin for uses not contemplated in the medication’s FDA certification.

The practice is legal, Gelb said, but doctors have been asked to restrict their use of immune globulin to the cases that need it most.

“For example, it has been used for chronic fatigue syndrome, and there is not a lot of evidence that it works for that,” Gelb said.

, DataTimes ILLUSTRATION: Graphic: Hepatitis A explained

MEMO: This sidebar appeared with the story: AT RISK Health officials estimate 13,000 to 20,000 people may have been exposed to the hepatitis A virus, based on customer counts at Players and Spectators restaurant in the Spokane Valley.