A McDonald’s in Johnson City, TN, and a Little Caesar’s Pizza in Newark, OH, put their customers at risk of exposure to hepatitis A by permitting an employee with the liver disease to report for work.

They are the latest in a long list of hepatitis A developments that are examples of what the Mississippi State Department of Health is calling a "national epidemic." Mississippi on Wednesday acknowledged that state has joined that epidemic.

"An outbreak occurs when we see an increased number of cases greater than what is normally expected over time," explained MSDH State Epidemiologist Dr. Paul Byers. "Since April we’ve seen 23 cases in Mississippi. We investigate all reported cases to identify their contacts and provide vaccination."

Anyone who is not vaccinated is at risk from the contagious liver disease from contact with an infected person experiencing jaundice and other symptoms. And it happens all too frequently in restaurants when an employee comes to work while infected with the virus,

That’s what happened in both Johnson City, TN, and Newark, OH. One employee carrying the virus for one shift at Tennessee McDonald’s potentially exposed 500 customers to hepatitis A. Health officials this week offered a two-day vaccination clinic.

Pot-exposure vaccination must be administered within two weeks after exposure to be effective.

The Little Caesar’s in Newark, OH, closed and held a vaccination clinic for its employees. It also conducted extensive cleaning and facility repairs, according to the Licking County Health Department. The risk to the public from the exposed employ is considered low.

The hepatitis A fire is burning hottest in Florida. From Jan. 1, 2018, through July 27, 2019, there have been 2, 582 hepatitis A cases reported in the state. In all of 2018 there were 548 hepatitis A cases reported. This year, thru July 27, 2019, there’s been 2,034 hepatitis A cases reported.

Florida’s main strategy for combating hepatitis A is vaccination. More than 4,000 vaccinations a week are being provided.

Other states that are not putting up those numbers are none-the-less concerned about the increase in hepatitis A cases over historical levels. Philadelphia, for example, recorded 19 hepatitis A cases in 2017; and 21 for 2018.

To date for 2019, Philadelphia reports 117 hepatitis A cases.

Like many cities, Philadelphia finds most hepatitis A cases involve homeless people and drug users. However, transmission through food and beverages is also a source.

Also this week, 13 hepatitis A cases were reported in Washington State. Ten are in Spokane, and three are in the Seattle metro area. Like Mississippi, Evergreen State health officials there said they are declaring a hepatitis A outbreak.

The federal Centers for Disease Control and Prevention (CDC) in Atlanta says there are two ways to transmit the hepatitis A virus (HAV) :

• Person-to-person transmission through the fecal-oral route (i.e., ingestion of something that has been contaminated with the feces of an infected person) is the primary means of HAV transmission in the United States.
• Exposure to contaminated food or water can cause common-source outbreaks and sporadic cases of HAV infection. Uncooked foods contaminated with HAV can be a source of outbreaks, as well as cooked foods that are not heated to temperatures.

Symptoms of hepatitis A include nausea, diarrhea, and vomiting; jaundice or the yellowing of the skin and eyes; and stomach pain, low appetite, and fever.

"In Mississippi, our most at-risk populations are those who use those who use recreational drugs, are currently in jail or were recently in jail, men who have sex with men, and those with unstable housing or who are homeless," said Dr. Byers. "Other states are seeing similar trends."

In addition to the vaccine, other prevention measures include practicing strong hygiene habits such as thoroughly washing your hands after using the bathroom.

"We are strongly recommending that all persons who are at higher risk get hepatitis A vaccine," said Byers. "Hepatitis A vaccine can be obtained through your provider, pharmacist and at all county health departments for uninsured or underinsured persons," said Dr. Byers.