The Tennessee Department of Health has identified an increase in hepatitis A cases across the state, many of which are tied to a large multi-state outbreak that began in early 2017.

“Hepatitis A is an infection that’s caused by a virus,” said TDH Immunization Program Medical Director Michelle Fiscus, “which is important to know because antibiotics don’t work against hepatitis A.”

Fiscus spoke recently to the Coffee County Board of Health about its efforts to work with local health officials and other partners to respond to Tennessee’s hepatitis A outbreak.


Multi-state outbreak

Tennessee cases sharing the risk factors seen in the multi-state outbreak began to be detected at the end of December 2017. Transmission is presumed to occur person-to-person and through recreational drug use, though Fiscus notes that high-risk groups also include those who are homeless and men who have sex with men.

The virus is spread primarily through stool, Fiscus said, and can be spread person-to-person, infecting the liver.

Those infected can be contagious for two weeks before and one week after they show symptoms. Most people become sick about a month after being infected.

Symptoms include jaundice (a yellowing of the skin and eyes), nausea, vomiting and diarrhea. The illness can range from mild to serious illness and in some situations, result in death.

To treat the symptoms of hepatitis A, doctors usually recommend rest, adequate nutrition and fluids. Though the infection will usually go away on its own, it can take a few months before people with hepatitis A begin to feel better, and some will need medical care in a hospital.

Notably, this outbreak has had a high hospitalization rate among those infected with hepatitis A.


Hep A is vaccine-preventable.

“We are actively working with all of our local departments of health and our metro partners to vaccinate people who are at high risk for developing or contracting that virus,” said Fiscus. “That’s people who are using recreational drugs, men who have sex with men, or people who are homeless or maybe don’t have access to hygienic living quarters.”

Anyone who is in one of those risk groups or has had direct contact with someone who has been infected with hepatitis A should be vaccinated with the hepatitis A vaccine.

“That vaccine is very effective and it’s very safe,” said Fiscus.

To get the full benefit of the hepatitis A vaccine, more than one shot is needed. The number and timing of these shots depends on the type of vaccine you are given. The first dose of the two-dose series will protect most people for several years. The two-dose series is all that is needed for a lifetime; it does not require booster doses.

People who wish to be vaccinated should check with their healthcare provider or pharmacist. It is also available through local public health departments, especially for adults at risk.

The vaccine is covered by most insurance plans.

Hepatitis A vaccine is routinely recommended for certain groups even in the absence of an outbreak. In addition to the high-risk groups listed above, they include people who travel to countries that have high rates of hepatitis A or who have adopted children from those countries; people who are treated with clotting-factor concentrates; and people with chronic liver diseases such as hepatitis B or hepatitis C.

Pediatric hepatitis A vaccine is recommended for all children and has been required for kindergarten entry in Tennessee since 2011.

Practicing good hand hygiene – including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food – also plays an important role in preventing the spread of hepatitis A, according to TDH.



Over the last five years, Tennessee has typically seen an average of 13 cases per year, often associated with travel to countries where hepatitis A is common. 

But since Dec. 1, 2017, the number of confirmed cases statewide has jumped to 1,571 (roughly 87 cases per month) and has resulted in nine deaths.


Coffee County

Over that 18-month time period, Coffee County stands out as having the highest number of reported cases (30-99) within its 13-county South Central region (129 cases).

Statewide, Coffee County cases are roughly on par with Sumner (Gallatin/Hendersonville), Putnam (Cookeville) and Dickson (Charlotte) counties. These four counties are only surpassed in the number of reported cases by larger counties that metropolitan-area cities – such as Davidson (Nashville), Rutherford (Murfreesboro) and Hamilton (Chattanooga).

The TDH asks that you report any suspected case of hepatitis A to your local health department immediately for case investigation. Each county in Tennessee has a local health department. In Coffee County, visit the Coffee County Health Department at 800 Park St. in Manchester or the Tullahoma Health Center at 615 Wilson Ave. in Tullahoma.

For additional information about this outbreak, visit