SALISBURY — The pandemic demanded much of the Rowan County Health Department’s attention in 2021, but another communicable disease emerged as a source of concern.

Cases of hepatitis A, a contagious liver infection caused by a transmittable virus, have increased across North Carolina since 2018 and continued that trend last year. The increase in cases have largely been clustered in the central and western part of the state. In the previous six months, the state has seen 123 hepatitis A cases, including 76 hospitalizations and three deaths.

In 2021, Rowan County recorded 72 cases of hepatitis A, a significant increase from the previous three years when 10 cases were recorded in total.  Over the previous six months, Rowan County is second in the state in number of new hepatitis A cases, with 11, trailing Caldwell County by just one and ahead of Gaston County with 10.

Angela Worley, Rowan County communicable disease supervisor, told the Board of Health on Tuesday night that hepatitis A is “in the forefront” of the department’s communicable disease concerns as the state’s cases have become “out of control.” 

Worley made those comments while presenting the board with the department’s annual communicable disease report. The Health Department is responsible for reporting a total of 75 different communicable diseases and has one full-time communicable disease nurse. With the influx of hepatitis cases, Worley said they could use one nurse simply to handle hepatitis follow ups.

Prior to the last half-decade, hepatitis A cases had become rare due to a vaccine first recommended in 1996.

Hepatitis A can be spread from close, personal contact with an infected person, including through having sex, caring for someone who is ill or using drugs with others. Hepatitis A is acute, which means it’s typically a short-term illness, and it almost always gets better on its own. Hepatitis B can be both acute and chronic or ongoing. Hepatitis C is almost always chronic.

Hepatitis A cases in North Carolina are mostly being found in people who use injectable or non-injectable drugs, people who are homeless and a few in men who have sex with men, Worley said. In North Carolina, 72% of cases are in people using drugs. That percentage is likely higher in Rowan County, Worley said. 

In Rowan County, Worley said about 50% of the people are infected with hepatitis C also. Rowan County recorded 412 cases of chronic hepatitis C in 2021.

During Worley’s presentation, Board of Health Vice Chair Amy Wilson said hepatitis A is a preventable disease with an available vaccine and asked if the department had done any pop-up clinics to distribute vaccines.

Worley said the Health Department worked to administer vaccines at the Rowan County Detention Center, but stopped due to the COVID-19 pandemic. That’s an activity that could resume in the future, she said.

The Health Department previously held a vaccine clinic at Rowan Helping Ministries, but Worley said the event didn’t produce the hoped-for vaccinations.

Moving forward, Health Director Alyssa Harris said the department will explore the idea of using the Post-Overdose Response Team to refer and provide resources to hepatitis patients. The PORT team, which works to combat drug-related overdoses in Rowan County, seems to be a natural tool due to the population it serves. The PORT team has been working to handle a dramatic uptick in overdose deaths in Rowan County since the beginning of the pandemic.

The increase in hepatitis cases came during a year in which most other communicable diseases saw their numbers decrease as people continued to follow COVID-19 protocols and traveled less. Only one case of Rocky Mountain Spotted Fever was recorded, down from six in 2020 and 13 in 2019. There was also only one case of lyme disease, down from six in 2020 and 17 in 2019. One case of chicken pox was reported in an adult male and one case of tuberculosis was reported in a person who arrived from outside of the country.

“It’s just a matter of folks not doing the normal activities they maybe had always done,” Worley said. “Not as much travel, those kinds of things.”

There were also no major disease outbreaks other than COVID-19 recorded in 2021.

“Normally we would have outbreaks in our long-term care facilities for flu, norovirus, those kinds of things, but there have been none of those reported to us in the year 2021,” Worley said.

Sexually transmitted diseases increased in 2021 after decreasing in 2020. The Health Department recorded 745 cases of chlamydia, 347 cases of gonorrhea and 78 cases of syphilis.

“Those numbers are right back up to where they were pre-COVID,” Worley said.

The Health Department plans on applying with the CDC for two public health associates, one of whom would help with sexual health outreach through a two-year, paid training program.