The recent hepatitis A outbreak at a McDonalds in Milan, Illinois, has claimed at least 26 victims, and has caused the local health departments to innoculate 5,366 people, hopefully catching these folks in the modest window of time to prevent an infected person from becoming ill. This raises a number of questions that we plan to find answers to.
First, at what cost does this innoculation program come to the affected counties? Not good timing, likely, considering the budgeting woes around the country. Second, how many people are "out of the woods"–i.e., people who were infected at McDonalds, but who received their innoculations in time to prevent the onset of symptoms. And finally, perhaps most importantly, what is the real human toll of this outbreak.
As is the case with an illness caused by any bacteria or virus, colloquially called "food poisoning," many people pass off even hepatitis A as some diarrhea, some vomiting, maybe a little jaundice too, and the victim recovers. True for some, but those would be the lucky ones . . . the exceptions to the rule. More typically, hepatitis A causes weeks, if not months, of symptoms. Ask anybody who has been unlucky enough to fall victim. The fatigue is debilitating. The illness (vomiting, nausea, etc.) is sometimes so extreme for so long that people miss enough work to lose their jobs. And the jaundice that typically signifies that "youre on the mend" sometimes causes such embarrasment that victims won’t go out in public.
But that’s just the "typical" hepatitis A illness. We have represented many people who have had not-so-typical illnesses. Here is a brief medical synopsis of how the virus can cause catastrophic liver failure (fulminant hepatitis), requiring liver transplantation for survival, or potentially causing death.
Fulminant hepatitis kills nearly 100 people each year in the United States. Among reported cases for all ages, the fatality rate is approximately 0.3%. This figure, however, increases with age. For sufferers of fulminant hepatitis over 40 years old, the fatality rate is approximately 2%.
Fulminant hepatitis affects the liver. Weighing around three pounds, the liver is the body’s largest organ. It is located in the upper right-hand portion of the abdominal cavity, beneath the ribs and right lung, and situated atop the stomach, right kidney, and intestines. It is known to have over 500 functions essential to the body’s health. Chief among these are (1) the production of bile, a substance that facilitates digestion in the small intestine; (2) ridding the blood of bacteria that cause infection; (3) ridding the blood of drugs and other poisonous substances; and (4) regulating blood clotting.
The hepatitis A virus (HAV) infects the liver’s parenchymal cells. Once a cell has been penetrated by the viral particles, the particles release their own toxins, which cause, in essence, a hostile takeover of the host cell’s system. The cell then produces new viral components that are released into the bile caniculi that run between the liver’s parenchymal cells. Thereafter, the affected liver cells are no longer able to perform their function. This process—i.e. the pathologic death of liver cells—is called hepatic necrosis.
The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its multifaceted job.
Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema. Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function. The several stages of encephalopathy, I through V, represent stages of ascending dysfunction—a stage III sufferer is in a stupor, incoherent and markedly confused, and stage IV and V sufferers are comatose. Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure. It is the leading cause of death in patients suffering from fulminant hepatic failure.
Treatment of those suffering from fulminant hepatic failure turns largely on the victim’s status. Those who have not become encephalopathic generally undergo an intense course of supportive treatment. But for those whose liver failure is so complete that it has lead to encephalopathy or cerebral edema, timely liver transplantation is often the only option. For these unlucky few, the process of necrosis has left their liver scarred and useless (image to the left).