1

Brief Description of Outbreak: In November 2017, the Kentucky Department for Public Health

(DPH) identified an outbreak of acute hepatitis A. The increase in cases observed in Kentucky was

well over the 10-year average of reported hepatitis A cases, and several cases have been infected

with hepatitis A virus (HAV) strains genetically linked to outbreaks in California, Utah, and Michigan.

Similar to hepatitis A outbreaks in other states, the primary risk factors have been illicit drug use and

homelessness. A contaminated food source has not been identified, and HAV transmission is

believed to have occurred through person-to-person contact. Below is a weekly and cumulative

update on the outbreak. Please note that all data is preliminary and subject to change as additional

reports are received.

In accordance with 902 KAR 2:020, cases of acute hepatitis A should be reported within 24 hours.

The case definition used for outbreak-associated acute hepatitis A cases is available upon request.

Table 1: Summary of Outbreak-Associated Acute Hepatitis A Cases*

* Cases are reported based on date of specimen collection

^ Cases are generally confirmed weeks after submission for testing, so will only be reflected in total case counts.

† Deaths are defined as any outbreak-associated acute hepatitis A case with documentation of hepatitis A as a contributing

factor to the individual’s death.

Update for Week 40: Total Case Counts: 8/1/2017 – 10/6/2018:

Number of new cases (n=83):

Confirmed^ - 0

Probable - 57 Suspected - 26

Total number of cases (n=2050):

Confirmed^ - 546

Probable - 987 Suspected - 517

Number of counties with new cases:

40

Total number of counties with cases:

91 (76% of KY counties)

Number of individuals with specimens submitted for genotyping where results are available:

0

Number of individuals with specimens submitted for genotyping where results are available:

583 (28%)

Number of cases with genotype IB among those with genotype testing:

0 Total number of cases with genotype IB among those with genotype testing:

530 (91% of those tested)

Number of Hospitalizations:

45 Total Number of Hospitalizations:

1126 (55%)

Number of deaths

Reported†:

0 Total number of deaths

reported†:

14 (<1%)

Kentucky Department for Public Health KY17-089 - Acute Hepatitis A Outbreak Weekly Report

Morbidity and Mortality Weekly Report (MMWR) Week 40, 2018 September 30, 2018 – October 6, 2018

2

Table 2: Cumulative Distribution of Cases by County

KY17-089 Distribution Of Outbreak-Associated Acute Hepatitis A Cases,

by County, August 1, 2017 – October 6, 2018*^#

County

Total number

of cases

reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Adair 2 0 1 1 10.3

Allen 19 1 14 4 90.8

Anderson 9 0 8 1 39.9

Ballard 9 3 2 4 112.0

Barren 4 1 3 0 9.1

Bath 14 0 5 9 113.1

Bell 4 0 1 3 14.9

Boone 24 1 14 9 18.4

Bourbon 3 0 3 0 15.0

Boyd 158 91 36 31 329.3

Boyle 5 0 1 4 16.7

Breathitt 1 0 1 0 7.7

Bullitt 62 28 25 9 77.3

Butler 3 0 1 2 23.4

Campbell 28 1 23 4 30.3

Carlisle 1 0 1 0 20.6

Carroll 3 0 0 3 28.0

Carter 126 39 63 24 464.2

Casey 2 1 0 1 12.7

Christian 1 1 0 0 1.4

Clark 8 0 6 2 22.2

Clay 5 0 3 2 24.6

Daviess 2 0 1 1 2.0

3

KY17-089 Distribution Of Outbreak-Associated Acute Hepatitis A Cases,

by County, August 1, 2017 – October 6, 2018*^#

County

Total number

of cases

reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Edmonson 1 0 1 0 8.2

Elliott 17 1 4 12 226.0

Estill 4 0 3 1 28.0

Fayette 25 2 17 6 7.8

Fleming 3 0 0 3 20.8

Floyd 41 0 23 18 113.0

Franklin 23 0 17 6 45.6

Gallatin 2 0 1 1 22.8

Garrard 4 0 2 2 22.8

Grant 27 3 19 5 108.1

Grayson 20 2 16 2 75.9

Green 2 0 2 0 18.1

Greenup 56 28 17 11 157.7

Hardin 28 7 5 16 25.9

Harrison 2 0 2 0 10.6

Hart 1 0 1 0 5.3

Henry 10 2 5 3 62.5

Hickman 1 0 0 1 22.1

Hopkins 1 0 0 1 2.2

Jackson 4 0 3 1 29.8

Jefferson 624 289 227 108 80.9

Jessamine 2 0 0 2 3.7

Johnson 26 0 13 13 115.1

Kenton 42 2 38 2 25.4

4

KY17-089 Distribution Of Outbreak-Associated Acute Hepatitis A Cases,

by County, August 1, 2017 – October 6, 2018*^#

County

Total number

of cases

reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Knott 12 0 10 2 78.5

Knox 22 0 12 10 70.5

LaRue 2 0 1 1 14.1

Laurel 31 0 25 6 51.5

Lawrence 18 3 10 5 114.5

Lee 4 0 4 0 60.9

Leslie 5 0 3 2 48.4

Letcher^ 1 0 0 1 4.5

Lewis 5 0 3 2 37.5

Lincoln 5 2 2 1 20.4

Logan 1 0 1 0 3.7

Madison 13 1 9 3 14.3

Magoffin 22 0 14 8 175.5

Marion 14 2 9 3 72.2

Marshall 2 0 1 1 6.4

Martin 25 0 16 9 218.3

Mason^ 1 0 1 0 5.8

McCracken 8 2 3 3 12.2

Meade 12 1 1 10 42.6

Menifee 12 0 8 4 185.9

Mercer 6 0 3 3 27.9

Metcalfe 1 0 1 0 9.9

Montgomery 57 5 40 12 204.1

Morgan 9 0 7 2 68.2

5

KY17-089 Distribution Of Outbreak-Associated Acute Hepatitis A Cases,

by County, August 1, 2017 – October 6, 2018*^#

County

Total number

of cases

reported

Number of

confirmed

cases

Number of

probable

cases

Number of

suspected

cases

Incident Rate

per 100,000

population

Nelson 14 4 5 5 30.7

Ohio 6 0 3 3 24.8

Oldham 8 3 3 2 12.0

Owen 3 0 3 0 27.9

Pendleton 4 0 2 2 27.4

Perry 13 0 5 8 49.0

Pike 10 0 9 1 17.0

Powell 7 0 5 2 56.6

Pulaski 3 0 1 2 4.7

Rowan 42 0 26 16 171.3

Russell 1 0 0 1 5.6

Scott 2 0 0 2 3.6

Shelby 20 5 11 4 42.2

Simpson 6 0 6 0 33.1

Spencer 5 3 1 1 27.0

Taylor 35 2 26 7 137.4

Warren 23 7 12 4 17.9

Washington 5 0 3 2 41.2

Whitley 91 3 51 37 251.3

Wolfe 5 0 3 2 68.8

Total Number of Cases:

2050 546 987 517 46.0

* Cases are reported based on date of specimen collection.

^ Denotes a county where cases have not been previously identified.

# As genotyping results become available, cases may be excluded if they do not meet the outbreak case definition. Cases

in the following counties have been excluded from the outbreak case count this week: None.

6

Figure 1: Geographic Distribution of Outbreak-Associated Cases by County

7

Figure 2: Major Interstates and Syringe Exchange Programs in Counties Reporting Outbreak-Associated Cases

8

Figure 3: Outbreak-Associated Cases by Age

* The mean age of cases is 37.9 years, and the median age is 36.0 years.

Table 3: Frequent Risk Factors of Outbreak-associated Cases

KY17-089 Risk Factors of Outbreak-Associated Acute

Hepatitis A Cases, August 1, 2017 – October 6, 2018#^

Risk Factor

Number of Cases

Reporting Risk Factor

(n=1684)* †

Homelessness + No Illicit Drug Use 18 (1.1%)

Illicit Drug Use + No/Unk Homelessness 1071 (64%)

Homelessness + Illicit drug use 198 (12%)

No Outbreak-Related Risk Factors 375 (22%)

* Risk factor information is unavailable for 366 (17.9%) of all outbreak-associated cases.

† The categories below do not add up to the total number in this count due to other possible risk factor combinations

not shown in the table. #

At this point in the outbreak, MSM is no longer considered an outbreak-related risk factor. Percentages in this table

may have changed due to removing MSM from risk factor combinations. ^

31 MSM cases have been reported. Of those, 9 have reported no other risk factors.

0

100

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0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89

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Age Range (years)*

KY17-089 Outbreak-Associated Cases of Acute Hepatitis A in Kentucky, by Age, August 1, 2017 - October 6, 2018

9

Figure 4: Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases

* MMWR weeks are based on date of specimen collection.

1 1 1 1 2 2 4 2 3 5 3 5 5 4 5 5 64 3

8

3

128 10 9

2225

17

29 28

53

43

49

57 57

46

68

57

53

83

6766

66

78

5761

54

5863

80

64

75

7175

73

73

87

83

0

10

20

30

40

50

60

70

80

90

100

Jul 29 -

Aug 0

5 (

31)

Au

g 0

6 -

Aug 1

2 (

32)

Au

g 1

3 -

Aug 1

9 (

33)

Au

g 2

0 -

Aug 2

6 (

34)

Au

g 2

7 -

Sep 0

2 (

35)

Se

p 0

3 -

Sep 0

9 (

36)

Se

p 1

0 -

Sep 1

6 (

37)

Se

p 1

7 -

Sep 2

3 (

38)

Se

p 2

4 -

Sep 3

0 (

39)

Oct 01 -

Oct 07 (

40)

Oct 08 -

Oct 14 (

41)

Oct 15 -

Oct 21 (

42)

Oct 22 -

Oct 28 (

43)

Oct 29 -

Nov 0

4 (

44)

Nov 0

5 -

Nov 1

1 (

45)

Nov 1

2 -

Nov 1

8 (

46)

Nov 1

9 -

Nov 2

5 (

47)

Nov 2

6 -

Dec 0

2 (

48)

Dec 0

3 -

Dec 0

9 (

49)

Dec 1

0 -

Dec 1

6 (

50)

Dec 1

7 -

Dec 2

3 (

51)

Dec 2

4 -

Dec 3

0 (

52)

Dec 3

1 -

Jan 0

6 (

01)

Jan

07 -

Jan 1

3 (

02)

Jan

14 -

Jan 2

0 (

03)

Jan

21 -

Jan 2

7 (

04)

Jan

28 -

Feb 0

3 (

05)

Fe

b 0

4 -

Fe

b 1

0 (

06)

Fe

b 1

1 -

Fe

b 1

7 (

07)

Fe

b 1

8 -

Fe

b 2

4 (

08)

Fe

b 2

5 -

Ma

r 3 (

09)

Ma

r 4 -

Mar

10 (

10)

Ma

r 11

- M

ar

17 (

11)

Ma

r 18

- M

ar

24 (

12)

Ma

r 25

- M

ar

31 (

13)

Ap

r 01 -

Apr

07 (

14)

Ap

r 08 -

Apr

14 (

15)

Ap

r 15 -

Apr

21 (

16)

Ap

r 22 -

Apr

28 (

17)

Ap

r 29 -

May 0

5 (

18)

Ma

y 0

6 -

Ma

y 1

2 (

19

)

Ma

y 1

3 -

Ma

y 1

9 (

20

)

Ma

y 2

0 -

Ma

y 2

6 (

21

)

Ma

y 2

7 -

Jun 0

2 (

22)

Jun

03 -

Jun 0

9 (

23)

Jun

10 -

Jun 1

6 (

24)

Jun

17 -

June 2

3 (

25)

Jun

24 -

Jun 3

0 (

26)

Jul 01 -

Jul 07 (

27)

Jul 08 -

Jul 14 (

28)

Jul 15 -

Jul 21 (

29)

Jul 22 -

Jul 28 (

30)

Jul 29 -

Aug 0

4 (

31)

Au

g 0

5 -

Aug 1

1 (

32)

Au

g 1

2 -

Aug 1

8 (

33)

Au

g 1

9 -

Aug 2

5 (

34)

Au

g 2

6 -

Sep 0

1 (

35)

Se

p 0

2 -

Sep 0

8 (

36)

Se

p 0

9 -

Sep 1

5 (

37)

Se

p 1

6 -

Sep 2

2 (

38)

Se

p 2

3 -

Sep 2

9 (

39)

Se

p 3

0 -

Oct 06 (

40)

Oct 07 -

Oct 13 (

41)

Oct 14 -

Oct 20 (

42)

Oct 21 -

Oct 27 (

43)

Oct 28 -

Nov 0

3 (

44)

Nu

mb

er

of

Cas

es

MMWR Week*

KY17-089 Epi-Curve of Outbreak-Associated Cases by MMWR Week, August 1, 2017 - October 6, 2018

10

Figure 5: Epidemic-curve (Epi-Curve) of Outbreak-Associated Cases by Month of Onset

* Date of onset has been reported for 79.2% (or 1624/2050) of cases.

0

50

100

150

200

250

300

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

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mb

er

of

Cas

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, August 1, 2017 - October 6, 2018 (Current month shown in gold - case counts are not complete)

11

Figure 6: Case count comparison of acute hepatitis A cases, Jefferson County versus Non-Jefferson Counties

* MMWR weeks are based on date of specimen collection.

0

10

20

30

40

50

60

70

80

90

Jul 2

9 - A

ug 0

5 (3

1)

Au

g 1

3 - A

ug

19

(33)

Au

g 2

7 - S

ep

02

(35)

Se

p 1

0 - S

ep

16

(37)

Se

p 2

4 - S

ep

30

(39)

Oct 0

8 - O

ct 1

4 (4

1)

Oct 2

2 - O

ct 2

8 (4

3)

No

v 0

5 - N

ov 1

1 (4

5)

No

v 1

9 - N

ov 2

5 (4

7)

De

c 0

3 - D

ec 0

9 (4

9)

De

c 1

7 - D

ec 2

3 (5

1)

De

c 3

1 - J

an

06 (0

1)

Jan

14

- Ja

n 2

0 (0

3)

Jan

28

- Feb

03 (0

5)

Fe

b 1

1 - F

eb 1

7 (0

7)

Fe

b 2

5 - M

ar 3

(09

)

Ma

r 11 - M

ar 1

7 (1

1)

Ma

r 25 - M

ar 3

1 (1

3)

Ap

r 08

- Apr 1

4 (1

5)

Ap

r 22

- Apr 2

8 (1

7)

Ma

y 0

6 - M

ay 1

2 (1

9)

Ma

y 2

0 - M

ay 2

6 (2

1)

Jun

03

- Ju

n 0

9 (2

3)

Jun

17

- Ju

n 2

3 (2

5)

Jul 0

1 - J

ul 0

7 (2

7)

Jul 1

5 - J

ul 2

1 (2

9)

Jul 2

9 - A

ug 0

4 (3

1)

Au

g 1

2 - A

ug

18

(33)

Au

g 2

6 - S

ep

01

(35)

Se

p 0

9 - S

ep

15

(37)

Se

p 2

3 - S

ep

29

(39)

Oct 0

7 - O

ct 1

3 (4

1)

Oct 2

1 - O

ct 2

7 (4

3)

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of

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MMWR Week

KY17-089 Outbreak-associated acute hepatitis A cases, by date of specimen

collection, August 1, 2017 to October 6, 2018 *

Jefferson

Non-Jefferson

12

Figures 7-10: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Boone, Campbell, Fayette, and Floyd Counties)

0

1

2

3

4

5

6

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Campbell County,

August 1, 2017 - October 6, 2018 (N=16)

0

1

2

3

4

5

6

7

8

9

10

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Fayette County,

August 1, 2017 - October 6, 2018 (N=18)

0

1

2

3

4

5

6

7

8

9

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Floyd County, August 1, 2017 - October 6, 2018 (N=23)

0

1

2

3

4

5

6

7

8

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Boone County, August 1, 2017 - October 6, 2018 (N=18)

13

Figures 11-14: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Franklin, Grant, Grayson, and Jefferson Counties)

0

1

2

3

4

5

6

7

8

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Grant County, August 1, 2017 - October 6, 2018 (N=17)

0

1

2

3

4

5

6

7

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Grayson County,

August 1, 2017 - October 6, 2018 (N=15)

0

10

20

30

40

50

60

70

80

90

100

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

Cas

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Jefferson County,

August 1, 2017 - October 6, 2018 (N=469)

0

1

2

3

4

5

6

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Franklin County,

August 1, 2017 - October, 2018 (N=11)

14

Figures 15-18: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Johnson, Kenton, Knott, and Knox Counties)

0123456789

10111213

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Kenton County,

August 1, 2017 - October 6, 2018 (N=33)

0123456789

101112131415

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Knox County, August 1, 2017 - October 6, 2018 (N=19)

0

1

2

3

4

5

6

7

8

9

10

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

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of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Johnson County,

August 1, 2017 - October 6, 2018 (N=25)

0

1

2

3

4

5

6

7

8

9

10

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

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Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Knott County, August 1, 2017 - October 6, 2018 (N=11)

15

Figures 19-22: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Laurel, Lawrence, Madison, and Magoffin Counties)

0

1

2

3

4

5

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Lawrence County,

August 1, 2017 - October 6, 2018 (N=11)

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1011

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Magoffin County,

August 1, 2017 - October 6, 2018 (N=21)

0

1

2

3

4

5

6

7

8

9

10

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Laurel County, August 1, 2017 - October 6, 2018 (N=19)

0

1

2

3

4

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Madison County,

August 1, 2017 - October 6, 2018 (N=8)

16

Figures 23-26: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Marion, Martin, Montgomery, and Perry Counties)

0

1

2

3

4

5

6

7

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Marion County, August 1, 2017 - October 6, 2018 (N=12)

0

1

2

3

4

5

6

7

8

9

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Martin County, August 1, 2017 - October 6, 2018 (N=20)

0

2

4

6

8

10

12

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Montgomery County,

August 1, 2017 - October 6, 2018 (N=47)

0

1

2

3

4

5

6

7

8

9

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Perry County, August 1, 2017 - October 6, 2018 (N=13)

17

Figures 27-29: Epidemic-curves (Epi-Curves) of Outbreak-Associated Cases in Counties with at least 10 reported cases in

the last 50 days, by Month of Onset (Rowan, Taylor, and Whitley Counties)

0123456789

10111213

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Rowan County, August 1, 2017 - October 6, 2018 (N=39)

0123456789

1011121314

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Taylor County, August 1, 2017 - October 6, 2018 (N=27)

0

4

8

12

16

20

24

Jul 17

Au

g 1

7

Se

p 1

7

Oct 17

Nov 1

7

Dec 1

7

Jan

18

Fe

b 1

8

Ma

r 18

Ap

r 18

Ma

y 1

8

Jun

18

Jul 18

Au

g 1

8

Se

p 1

8

Oct 18

Nov 1

8

Dec 1

8

Nu

mb

er

of

Cas

es

Month of Onset*

KY17-089 Epi-Curve of Outbreak-Associated Cases by Month of Onset, Whitley County,

August 1, 2017 - October 6, 2018 (N=70)