10/29/10 — Two new cases of hepatitis reported

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Two new cases of hepatitis reported

By Phyllis Moore
Published in News on October 29, 2010 2:12 PM

MOUNT OLIVE -- The number of cases of hepatitis B at GlenCare assisted living facility continue to rise, and state health officials said Thursday that although the investigation is incomplete, a recurring theme has been detected among them.

The state announced last week that since August five residents had been diagnosed with hepatitis B and that four had died. As of Wednesday, two additional cases have been reported.

Seven possible cases, all from one facility, is "a lot of people," said Julie Henry, public information officer with the N.C. Division of Public Health.

"In addition to those five lab-confirmed cases, there were two more lab-confirmed cases of hepatitis that came as a result of testing. I do not know what their status was. My understanding was that one of those was hospitalized," she said.

GlenCare has been very cooperative and responsive, offering vaccines to everyone at the 104-bed facility, which is estimated to be at about half-capacity, Ms. Henry said.

"My understanding is that they tested the people in the facility. They're also trying to contact people that were living in the facility back to Jan. 1, 2010, but there may be additional people that need to be reached," she said. "Anybody that tested negative will be retested in three months. That's just standard procedure. And if they tested negative, we do chart reviews, asking if they have other (health problems)."

Hepatitis B, a contagious virus that can cause serious liver problems, also presents other challenges, Ms. Henry said.

It does not always present obvious symptoms, the elderly are particularly susceptible and not everyone who gets it requires treatment.

"Some people will recover on their own," she said. "For some people, it's chronic and for some people they need to be treated. We're kind of the detective. It might be that they came to the hospital (at different times) or they may not all have seen the same doctor.

"According to our regulations or statutes or rules, it's the physician's responsibility to report a case of hepatitis to the Health Department, even one case."

The recent outbreak has not followed a clear-cut pattern since it was first detected in late August, Ms. Henry said.

"Some of them might have been admitted to the hospital for something else and ... clues started being pieced together. Then they noticed that there were connections," she said. "Our job was to come in and find out what the source was."

While the investigation into the situation remains incomplete, a common denominator has surfaced, officials said -- all the patients who tested positive for hepatitis B have been diabetic.

"You look at what was the same. That was one of the first things about Wayne County and we came in and observed, talked to staff and reminded them of proper procedures," Ms. Henry said. "The fact that the initial group that we looked at were diabetic led us to look at medical devices. In other instances of outbreaks in similar settings or in this age group, there has been a link to medical devices.

"I think the main thing for us, our job is not really to point fingers but to find out how we can prevent any further spread and what we can learn from this so that we can better educate other assisted living homes and individuals out there. ... It's a horrible thing that anybody dies and we want to make sure that nothing like that happens."

In a case like the outbreak at GlenCare, there are several steps the state takes.

"One thing is to try to determine the source of the outbreak or what's led to these infections and then the related thing is figuring out what we can do to make sure no one else is infected, control measures, and those things happen at the same time," said Dr. Zack Moore, an epidemiologist with the N.C. Division of Public Health. "We immediately work with the Wayne County Health Department to get some recommendations out. We know it's hepatitis B. We know there have been outbreaks with diabetes.

"Right now we want to get some information out to them to make sure everything was done in a safe way. As we go along, we want to determine how this happened that might lead us to different control measures."

Two things are coming into play, Moore said -- keeping patients and the public safe and increased education.

"It's safe to be around people who have hepatitis B, it's not spread from casual contact," he said. "Overall, we're looking at it from this country as a whole. It's spread commonly by sexual contact, but when you look at long-term care facilities, it's more common in a setting like this to be blood contact. ... It's not spread by hugging, kissing, holding hands. It's not a flu or a cold or food-borne."

In the case of GlenCare, it appears that most if not all of those who have been identified had blood sugar monitors, Moore said.

"I don't want to say that we know that's happening at this point but that's a common outbreak in those kinds of settings and we know that a lot of these folks do get their blood sugar checked," he said. "The facility has been very cooperative and very responsive to our recommendations to them. I think the facility has done everything that we have asked them to do to minimize anyone else getting infected."

The state has likewise tried to get the word out to other long-term care facilities across the state, making sure they are also aware of the risks of spreading the disease and making sure procedures are followed.

"As far as educating the public, I don't mean to speak prematurely because the investigation is still under way," he said. "It's important for the public to realize that diseases can be spread in public health care settings, whether that's in a nursing home or a hospital.

"It's also important for people to feel empowered, that it's OK to ask their doctors or people taking care of them what steps they're taking to be sure that they're safe -- washing their hands when they come into the room, if they're having any procedure that involves needles, talking to (the provider) and asking what they're doing to prevent the spread of infection."

Moore said he realizes that the latest outbreak has created some anxiety in the surrounding community.

"I know that folks are probably worried about having contact with people who live there or people who work there," he said Thursday. "I hope that we can get the word out that there's not a concern. This is not something you're going to pick up from being with someone who's there or has the infection; it's not that kind of disease.

"Unfortunately, this isn't a unique situation. We have seen in North Carolina other outbreaks of these kinds of things and nationwide, there's been more and more of these identified."

Moore said his office remains in contact with the Centers for Disease Control in Atlanta and has had representatives at GlenCare almost every day since the outbreak began.

"They're doing the investigations but they're also following up and observing, making sure that everything's done safely," he said. "As far as getting results back, that's just kind of a rolling process.

"It could be quite some time before we have a final report because it takes some time to do all of the analysis. But we do look at it as it comes in. So far, we have seen that almost everybody's who's been involved has the blood glucose monitoring so that's where we're focusing our attention right now."