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December 1st, 2008
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Preventing panic

Health officials abate public fears of hepatitis A epidemic

By Ondřej Bouda
Staff Writer, The Prague Post
October 8th, 2008 issue

JAN PŘEROVSKÝ/THE PRAGUE POST
Most Prague pharmacies are sold out of the hepatitis A vaccine, and no one knows exactly when more supplies will be made available to the public.
Hepatitis A facts



Cause of infection: Poor hygiene, contaminated food or water, personal contact
Symptoms: Fever, fatigue, headache, loss of appetite, nausea and vomiting, abdominal pain, diarrhea, yellowish skin and eye whites
Treatment: Most recover within several weeks
Prevention: Ensure level of personal hygiene, avoid eating raw or undercooked food; get vaccinated

Health workers in Prague are scrambling to quiet concerns and contain a hepatitis A outbreak that has afflicted around 750 people since the beginning of the summer. The situation is the worst since 1999, when over 900 people had the disease. For years, locally reported cases have hovered around 100 to 200 per year.
The epidemic first appeared at the start of the summer holidays in Prague, among the city’s homeless and drug-addicted population. City Hall vaccinated more than 1,000 people, and reportedly managed to stem the spread of hepatitis among this high-risk community.
However, it was apparently too late by then, and the disease managed to spread to the general population. More cases have already been reported in Prague than recorded in the whole country last year, and the disease has now spread to other regions.
As panicked residents rush to obtain vaccines at local pharmacies, Chief Health Officer Michael Vít is trying to calm the situation. “There is no reason to panic,” he said. “We have everything under control and the spread of hepatitis is slowing down.”
Several municipal offices have decided to vaccinate their employees, as well as city police officers. “We want to ensure the safety of our workers, who [often] come into contact with the public,” said Prague 5 district Deputy Mayor Jan Smetana.
The municipal office has earmarked 125,000 Kč ($7,000) for vaccines and 190,000 Kč for the disinfection of elementary schools and kindergartens. Prague 2 and 10 have also decided to immunize their clerks, while Prague 7 has decided to provide the shot to their municipal policemen.
“The request originated at the municipal police,” said Prague 7 spokesman Martin Vokuš. “We evaluated it as reasonable, because the policemen spend their days on the streets among all sorts of people.”
Prague City Hall has also provided 3.4 million Kč for extra disinfection in schools and vaccines in case of an emergency. “Even though hepatitis usually spreads among children in schools, we know of only 40 cases so far this year,” Vít said. “Most patients are 20 to 40 years old.”
Public transport is thoroughly cleaned during the night in order to prevent any spread of the disease through the use of buses, trams and the metro, he added.
Despite all preventive measures and constant assurances from politicians and doctors, Prague residents are becoming anxious. Pharmacies in Prague have sold out of all vaccines, and no one seems to know when more are going to be available.
Estimates range from two weeks to several months. “People keep coming in all the time looking for the vaccine, but there simply is none left and we have no idea when more will be available,” said pharmacist Martin Veselý.
In what appears to be a consequent profiteering effort, one anonymous offer on the Internet promised to sell one shot for 4,600 Kč, four times the usual price. It also warns that the epidemic is not over yet, and that the only protection is a vaccine.
“The Web page contains alarming and untruthful information,” said Health Ministry spokesman Tomáš Cikrt. “We are already investigating the case.”
Vít says all at-risk individuals are closely monitored. “We are informed by general practitioners and contact the employers of patients with hepatitis,” he said. “They then provide us with a list of the closest co-workers who have to get tested for hepatitis and are monitored for 50 days in order to eliminate the risk of spreading the disease.”
However, the reality is often different. When a General Health Insurance (VZP) clerk was diagnosed with hepatitis, co-workers wondered at the lax approach of the local health office.
“There are 20 of us in the office,” said a VZP employee who wished to remain anonymous. “We share a kitchen and a toilet, which are areas with the highest risk of contamination, but inclusion on the list was voluntary and, in the end, only eight people put their names down. We will be monitored, while the others are free to do as they will and spread the disease if they have it.”
Instructions for the potentially infected included avoiding cinemas and theaters, as well as leaving cooking to spouses as much as possible, “but we can travel on the public transport each day to work and back,” said the VZP employee.
Some people have started wearing gloves while using public transport to minimize chances of contamination.
Vít, however, remains calm. “The unnecessary panic has even spread abroad. Tourists are canceling their vacations to Prague,” he said. “I would like to assure everyone that the country is safe. We have had no cases of hepatitis in restaurants and hotels.”
Dubbed the “dirty-hand disease,” hepatitis A is most commonly communicated through the digestive system. According to doctors, the best prevention is a thorough scrub after using the toilet and before eating.
While type-A hepatitis is not life threatening, it can cause severe problems. Initial symptoms resemble a cold: headaches, stomach cramps and stiff joints. The telltale sign of liver failure are yellowish skin and eye whites, often accompanied by digestive irregularities. The incubation period is 14 to 50 days.
The historically worst epidemic of hepatitis A took place in Czechoslovakia in 1977. Some 30,000 people contracted the disease from infected Polish strawberries.

Ondřej Bouda can be reached at obouda@praguepost.com


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Reader's comments:

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[12:55 12/10/2008] : An increase of 150 cases per year is a 1/8000th increase. If your paper is writing about preventing panic objectively, why are the letters in the word "panic" in large, red capital letters that dwarf the word "preventing" in the headlines? Mr. Bouda, who comes from the Czech tabloids, must be pleased with this packaging, of course. So did it jack up your sales?
Kim Spivak
Prague
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