A nurse prepares a vaccine injection at Eastern Maine Medical Center in Bangor. Public health experts in Maine say widespread vaccination is the best way to prevent an outbreak of Hepatitis A, currently surging in several other states. Credit: Erin Fredrichs

Hoping to avoid a surge in Hepatitis A cases in Maine, the Maine Center for Disease Control and Prevention this week issued recommendations for protecting against the highly transmissible viral disease.

Four cases of Hepatitis A have been reported statewide in the past four months, for a total of six cases so far in all of 2017.

“This is not an outbreak, and we don’t want an outbreak,” said State Epidemiologist Siiri Bennett.

She would not specify the exact dates of the 2017 cases or say where in Maine they were identified.

“We can’t talk about individual cases,” she said. “They’re scattered all across the state.”

However, she said, other states are grappling with serious outbreaks of Hepatitis A, and Maine is not immune.

“The message we want to get out is that this is a preventable illness,” she said.

The best line of defense is a widely available vaccine, she said, along with careful handwashing, safe food handling and other hygienic practices.

Hepatitis A, caused by oral exposure to the feces of an infected person, is a reportable disease, meaning health providers must inform the state when they confirm a single case or a cluster of cases. Not all cases are identified, though, as common symptoms of Hepatitis A are similar to those of other illnesses and include fatigue, loss of appetite and nausea. Some cases also include a yellowing in the eyes, dark-colored urine and clay-colored stool.

Common exposure occurs through consuming contaminated water or food, as well as through sexual activity. Illness may last weeks or months.

There is no effective treatment, but in almost all cases, infected individuals fully recover from Hepatitis A on their own without developing chronic disease or permanent liver damage. This is not true of Hepatitis B or Hepatitis C, which are caused by exposure to blood and body fluids and can result in lifetime illness.

Hepatitis A is associated with poverty and crowded living conditions and is more common in developing nations than in the U.S. In 2015, 1,390 cases were reported nationwide, according to the U.S. CDC.

However, in 2017 several states, including areas of California, Colorado and Michigan, have reported sharp increases in Hepatitis A, thought to be related to growing rates of drug use and homelessness, according to the U.S. Department of Health and Human Services.

In Maine, according to Maine CDC data, there were just eight cases reported in each of the past three years.

Although outbreaks of Hepatitis A are often associated with unsafe food handling in restaurants, public suppers and other food service venues, Bennett said the 2017 cases did not appear to stem from those group settings.

In the event of an outbreak, in which numbers of cases are connected to each other and to a single event or location, Bennett said the Maine CDC would send experts to investigate the source of the contamination, test for the virus and provide education to those at risk.

But until and unless Maine’s Hepatitis A rates rise, she said, preventive strategies are a personal responsibility.

Steps to avoid getting or spreading Hepatitis A include:

— Careful hand washing, especially after using the bathroom, changing a diaper or engaging in sexual activity. Always wash hands before preparing or eating food.

— Vaccination is recommended for anyone over the age of 1 year, especially people who travel in areas where Hepatitis A is common, people who are homeless, men who have sex with other men, people with chronic liver disease and those who use injectable and non-injectable drugs.

— Travelers and others may ask a medical provider about acquiring a supply of immune globulin which contains protective antibodies against the virus.

— Seeing a health care provider promptly if you suspect you have been exposed to Hepatitis A, in order to avoid transmitting the virus to people around you.

For information about Hepatitis A, visit the infectious disease epidemiology program on the Maine CDC website.

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Meg Haskell

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at mhaskell@bangordailynews.com.