Kentucky lawmakers on Monday confronted the statewide spread of hepatitis A, advancing a proposal calling for an examination of the state's response to one of the country's worst outbreaks of the disease.
Senate Minority Floor Leader Morgan McGarvey said the goal is to determine how the deadly outbreak occurred, how it spread and how outbreaks can be prevented.
"There's no blame to assign yet because we don't have any answers," the Louisville Democrat told the Senate Health and Welfare Committee, which advanced his resolution.
The proposal next goes to the Republican-led Senate. The measure calls on the state Cabinet for Health and Family Services to review public health officials' response to the statewide outbreak and to make recommendations aimed at better combating future outbreaks.
Hepatitis A is a contagious liver disease. In Kentucky, the outbreak began in late 2017 in the state's biggest urban area in Jefferson County and spread to rural areas. Statewide, more than 4,100 have been sickened by hepatitis A and more than 2,000 people were hospitalized. There have been 43 deaths associated with hepatitis A.
"This is not a political issue for us," McGarvey told the committee. "Forty-one hundred infected; 43 died. I don't know if these were Democrats. I don't know if they were Republicans. I know they were Kentuckians."
Dr. Jeffrey Howard, commissioner of the state Department for Public Health, said later that state health officials would welcome the review.
"We in public health and the cabinet are always looking at our responses, so this is nothing new," he said in an interview. "We'll just be making a report available to our legislators."
Howard said he sees the review as a chance to promote the importance of public health efforts statewide. Local health departments statewide will have a role in the review, he said.
The resolution follows a Courier Journal investigation that detailed the state's response to the deadly outbreak as it swept through eastern Kentucky, spread largely by drug users and the homeless. About one in five of those infected, however, were in neither of those risk groups, the Louisville newspaper reported.
The newspaper said its investigation found that the state's former infectious disease chief had recommended in May 2018 an aggressive $10 million response to combat the outbreak, including $6 million for vaccines and $4 million for temporary workers in thinly staffed health departments.
Howard said Monday that his department provided $3.7 million — a combination of state and federal funding — throughout 2018 to purchase more than 100,000 hepatitis A vaccines.
"At no point, to my knowledge, was there ever a shortage of vaccine," Howard said Monday. "There was a shortage of federal vaccine, but there has never been a shortage of private stock vaccine during this entire outbreak. So vaccine has always been available."
The review would offer a chance to examine how the state public health department works with the local health departments in times of disease outbreaks, Howard said. The goal is for state and local public health agencies to work more cohesively during outbreaks, he said.
"There are several changes that could happen to our system that I think will position us better for an outbreak into the future," he said.
"For example, if I was able to, in the event of an outbreak, be able to say to a health department, 'OK, we need to hold a vaccine event at this time. You and your staff are going to do that since you're the arms and legs of public health.' If I was able to compel them to do that with some weight, that would certainly help," he added.
Hepatitis A is transmitted by oral contact with fecal matter, even in microscopic amounts. It attacks the liver and causes symptoms including abdominal pain, nausea, diarrhea, fever and jaundice.
