Merced County health officials have warned doctors and hospitals about an outbreak of hepatitis A. From January through June 8, the county reported 42 cases, compared with 10 in all of 1997. In the past two days, an additional seven cases have brought the total to 49.

"These cases are above normal levels," said Michael Ford of the county's Public Health Department. "But there is reason to believe that they may be connected, so we're doing some intervention to identify potential contacts."

Four cases have been reported in Stanislaus County in the past two days, bringing the total for the year to 13.

Hepatitis A attacks the liver and is rarely fatal. It causes jaundice, fatigue, stomach pain and loss of appetite. Hepatitis A is fatal only when hepatitis B and D, which are blood infections, are combined with it, said Karen Resner, public health and communicable disease manager for Merced County.

The disease spreads through contact with human feces. The best defense is to wash food, utensils and hands. An infected person may be contagious for up to two weeks before symptoms occur. Often, one case can lead to several others.

"We're trying to identify clusters in the community," said Cathy Raevsky, Merced County deputy director of public health. "These areas are under investigation to ... find out who else may be contaminated."

Stanislaus County officials are monitoring the situation, hoping to avoid a repeat of the 1993 outbreak that saw 621 cases. There were 52 cases in 1997.

"We're watchful," said Linda Courtney, communicable disease specialist for the Health Services Agency. "There seems to be a cycle ... due to people moving who have not been exposed (to the disease)."

Once infected with hepatitis A, victims are injected with immune globulin so they don't spread it.

There is a nationwide shortage of immune globulin, Courtney said. Only two companies make it. So far, the shortage hasn't caused a problem in either county.

Simple steps can prevent Hepatitis A

Hepatitis A is contracted through exposure to the feces of an infected person. It can be introduced through toys, tools or hands.

People who work with diapered children or in food industries are most susceptible and most likely to spread it. Steps to prevent disease:

• Wash hands with soap and running water for at least 20 seconds after using the bathroom or changing diapers. Turn off faucets with a paper towel to avoid recontamination.
• Thoroughly clean hands with soap after using the bathroom.
• Wash hands after sneezing, coughing, blowing your nose, playing with a pet or cleaning up after a pet, playing outside, exposure to body fluids or waste, before giving medication or dealing with food.

Reprinted by permission of Modesto Bee.