Two Contoocook women speak about hep A diagnoses, public health response
Angie Snow was sitting in the emergency room with her mom when she overheard the doctor who had run hours of tests on her talking on the phone outside the door.
The doctor was speaking to a state public health official, and he was talking about a patient who had contracted a virus he needed to report.
“My mother and I are looking at each other like, ‘Who is that?’ ” Snow, 27, said.
“It ended up being me.”
The emergency room doctor diagnosed Snow with hepatitis A, a virus that attacks the liver, at the beginning of August.
At the time, Snow didn’t know what hepatitis A was. And she could not have predicted the way panic spread like a virus of its own through the small village of Contoocook when she left the emergency room that day.
“I went home and everything just exploded,” Snow said. “It turned into a living nightmare.”
Hepatitis A is not life-threatening, and its symptoms are most similar to the flu. Snow suffered a fever, exhaustion, body aches and jaundice. She could barely eat for two weeks.
Snow’s symptoms are gone, and her health is restored. But the effect of the hepatitis A diagnosis has infected her life ever since the day she left the emergency room. She went home to recover, choosing not to stay in the hospital because she does not have health insurance.
Then came three or four calls a day from the New Hampshire Department of Health and Human Services. Public health officials asked about a recent trip to Chicago to visit her brother, what she had been eating and drinking in past weeks, who she had seen and where she had worked.
Then came public announcements about hepatitis A and huge vaccination clinics. More than 1,000 people received vaccinations for the disease in August.
Then came health inspectors in the Contoocook Covered Bridge Restaurant, where Snow and her roommate Carrie Williams worked as bartenders and hostesses. The restaurant has passed every health inspection before and after the state’s investigation into the infection, and there is no evidence customers are at risk for hepatitis A while eating there. But owner Donna Walter said business is still down by 40 percent.
Then came a second hepatitis A diagnosis, this time for Snow’s roommate, Williams. Facing a more severe case, Williams spent six days in Concord Hospital and then three more days at the Lahey Hospital and Medical Center in Burlington, Mass. The cycle of questions from the state public health department, the health inspectors, the vaccinations – with Williams’s diagnosis, the two women lived through it all over again.
Unhappy with the state
Williams, 38, was discharged from Lahey the first week of September. She said her fever is gone and her jaundice is starting subside. But her disappointment with the state public health department has not disappeared.
“The way that (public health officials) represented it, all these people are panicking about it,” Williams said. “They’re not educating everyone, including myself.”
Williams worked two shifts at the Covered Bridge Restaurant between Snow’s diagnosis and her own. A public health nurse advised her to get the hepatitis A vaccine, but did not tell her she could put the restaurant at risk again by bartending.
“There were signs on the highway, ‘Hep A vaccination clinic today at 6 p.m.’ ” Williams said. “Big neon signs in our little town. How about a neon sign in my home? ‘Carrie, don’t go to work.’ ”
“They said, ‘Practice good hand washing.’ Period. That’s it.”
Beth Daly, chief of infectious disease surveillance at the New Hampshire Department of Health and Human Services, said health care providers and laboratories are required by law to report any hepatitis A cases to her office because it is a communicable disease.
Hepatitis A is spread when food, water or utensils are contaminated with fecal matter, or through sexual contact. It is easily transmittable, Daly said, and only requires 10 small viral particles to cause infection.
If the patient is not a food service worker, Daly said her office will interview the sick individual, advise his or her household to be vaccinated against the disease and sanitize their home, and then close the case.
If the patient is a food service worker like Snow or Williams, Daly said the state will advise his or her employer on how to protect against spreading the infection and will host vaccination clinics to immunize anyone who may have come in contact with the disease. Before this summer, the last public health clinic in this area related to hep A was in 2004.
A walking germ
For Snow, the immunization clinics and public health pamphlets made her a pariah, a walking germ no one wanted to touch. In a village the size of Contoocook, a town where everybody knows everybody else, she said everybody immediately knew who the supposedly nameless hepatitis A patients were.
“It kind of bums you out, because it’s a small town, you go and get a coffee somewhere else because people look at you sideways,” Snow said.
Snow still does not know where she originally contracted hepatitis A, she said, but believes many people misunderstood the information distributed by public health officials on what “fecal to oral” transmission of a disease like hepatitis A means.
“I went to Chicago, and I rode on a bus,” she said. “I could have touched a handle. I used to bite my fingernails. I could get hepatitis from (particles on the bus rail).”
“I would rather have been in there (at the immunization clinics) on the hot seat all day and have people ask me what was going on.”
And once the word is out and the clinics close, the Bureau of Infectious Diseases leaves. Three days after Snow got home, calls and questions from the bureau stopped. Williams answered questions by phone while she was in Concord Hospital during the first days of her illness, but neither roommate has heard from a public health official since then.
Daly said her office does not monitor these cases through their recovery because its concern is primarily any risk of infection for the community at large.
“We don’t follow them because we don’t provide individual health care,” Daly said. “We’re a public health agency, so we’re only assessing them for a public health risk. Once we finish with a disease control activity, we don’t continue to follow them.”
Snow has returned to a second job bartending at the American Legion, but neither woman is working at the Covered Bridge Restaurant right now. The restaurant has cut hours and part-time employees because business is still down, restaurant owner Walter said, and the two former bartenders have not been put back on the schedule.
Both women said they were unsure if they would have a job at the Covered Bridge in the future.
“Eventually they can work here, but not now. . . . This is our scar,” Walter said.
Snow and Williams are only the fourth and fifth people in New Hampshire to contract hepatitis A so far this year. No new cases of the disease have been reported since their diagnoses. But uneasiness about hep A lingers in Contoocook, even if the infection itself is gone.
“This is a small town, and it takes a little more delicacy,” Snow said. “Now you’re running a business . . . into the ground and people can’t support their families, and you’re running two women into the ground because people are freaked out and they think you’re ridden with disease.
“Take a moment and put yourself in our shoes.”
(Megan Doyle can be reached at 369-3321 or firstname.lastname@example.org or on Twitter