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Hepatitis A Outbreak Description and Overview

Hepatitis A Outbreak Description and Overview

Hepatitis A Southeast Michigan Outbreak

Public health officials and the Michigan Department of Health and Human Services (MDHHS) are continuing to see an elevated number of hepatitis A cases in the City of Detroit, and counties of Macomb, Monroe, Oakland, Wayne, and St Clair. Since the beginning of the outbreak in August 2016, public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. “Together with our local health partners, we are increasing outreach to vulnerable populations to raise awareness and promote vaccination of hepatitis A,” said Dr. Eden Wells, chief medical executive of MDHHS. “Those who live, work, or play in the city of Detroit, as well as Macomb, Oakland, and Wayne counties are urged to get vaccinated for hepatitis A and talk to their healthcare provider about their risks.” No common sources of food, beverages, or drugs have been identified as a potential source of infection. Transmission appears to be through direct person-to-person spread and illicit drug use. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate.
 

Southeast Michigan Hepatitis A Outbreak Cases and Deaths as of September 15, 2017*
*Table will be updated weekly by 4:00pm each Friday

Cases

Hospitalizations

Deaths

319

253 (85.5%)

14 (4.7%)

Please note: Table does not include all reported hepatitis A cases in the region; only those that are identified as outbreak-related. More descriptive data on the current outbreak can be found at (hyperlink to CD section of site).  Data are provisional and subject to change.

Hepatitis A Overview

Hepatitis A is a serious, highly contagious liver disease caused by the hepatitis A virus (HAV). HAV is found in the feces (poop) of people with hepatitis A. You can get hepatitis A by eating contaminated food or water, during sex, or just by living with an infected person. Illness can appear 15-50 days after exposure and you can be sick for several weeks. In some cases, people can die. Although not all people infected with hepatitis A experience illness, symptoms can include:

  • nausea and vomiting
  • belly pain
  • feeling tired
  • fever
  • loss of appetite
  • yellowing of the skin and eyes
  • dark urine
  • pale-colored feces (poop)
  • joint pain

There are steps you can take to reduce the risk of Hepatitis A transmission. Hepatitis A is a vaccine-preventable illness. While the hepatitis A vaccine is recommended as a part of the routine childhood vaccination schedule, most adults have not been vaccinated and may be susceptible to the hepatitis A virus. The best way to reduce the risk of getting hepatitis A is to get vaccinated with two doses of Hepatitis A vaccine. It is also recommended to wash your hands after going to the bathroom and before preparing meals for yourself and others. Use your own towels, toothbrushes, and eating utensils. Do not have sex with someone who has HAV infection or share food, drinks, or smokes with other people.

What can the public do to protect themselves and their communities?

  • Get vaccinated against hepatitis A
  • Wash hands after using the restroom and before eating or preparing meals for yourself or others
  • Use your own towels, toothbrushes, and eating utensils
  • Do not have sex with someone who has HAV infection
  • Do not share food, drinks, drugs, or smokes with other people
  • If you think you may have hepatitis A, see your medical provider
  • If you have hepatitis A, please cooperate with your local public health to help protect others

Public Health Response

Community Vaccination Clinics

MDHHS and local public health have conducted timely interviews to identify close contacts necessary to administer post-exposure prophylaxis and mitigate further transmission. Despite this significant collective effort, the outbreak persists. To end this outbreak, vaccination rates need to be increased among the highest risk individuals. Working with community partners, vaccination efforts are being implemented in targeted locations such as homeless shelters, soup kitchens, and rehabilitation facilities. Partnerships are also being developed with area Emergency Departments, county jails and state prisons.   

Immunization Information

Hepatitis A can be prevented with a safe and effective vaccine. Stop the spread of this infection.

Who Should Get the HAV Vaccine?

  • Persons who are homeless.
  • Persons who are incarcerated.
  • Persons who use injection and non-injection illegal drugs.
  • Persons who work with the high risk populations listed above.
  • Persons who have close contact, care for, or live with someone who has HAV.
  • Persons who have sexual activities with someone who has HAV.
  • Men who have sex with men.
  • Travelers to countries with high or medium rates of HAV.
  • Persons with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C.*
  • Persons with clotting factor disorders.
  • Any person who is concerned about HAV exposure and wants to be immune.

*Note: individuals with chronic liver disease (e.g., cirrhosis and hepatitis C) may not be at increased risk of getting HAV infections but are at increased risk of having poor outcomes if they are infected with HAV.

For information on where to get vaccinated:

If you (or someone you know) do not have health insurance, you will likely qualify for free or low cost vaccines. Talk with your local health department to find out if you qualify.

Detroit Health Department
Phone: 313-876-4000

Wayne County Department of Health, Veterans & Community Wellness  
Phone: 734-727-7078

Macomb County Health Department
Phone: 586-469-5372

Monroe County Health Department
Phone: 734-240-7800

Oakland County Health Division
Phone: 1-800-848-5533 or
Email: noc@oakgov.com

St. Clair County Health Department
Phone: 810-987-5300

For additional local health department information, contact the Division of Immunization.
Phone: 517-335-8159

Communicable Disease Information

Transmission Mitigation and Surveillance Strategies

MDHHS and local public health have participated in multiple meetings to discuss outbreak activities related to case-finding, contact tracing, post-exposure prophylaxis (i.e., immunoglobulin and HAV vaccine), notification to high risk facilities, and mass vaccination strategies. Prompt identification and interview of new cases help to determine exposure to HAV and close contacts allowing for timely administration of post-exposure prophylaxis to prevent further transmission. The MDHHS Communicable Disease Division has developed a supplemental questionnaire that is being used by public health investigators to identify high risk groups and to better direct public health interventions. Because of the high number of cases being reported, the MDHHS OutbreakNet Enhanced student interviewing team has assisted some counties with interviewing case-patients. Clinical specimens are also being requested from clinical laboratories to be submitted to the State Laboratory for further testing at the Centers for Disease Control and Prevention. The testing identifies which cases are part of the outbreak allowing public health to track any changes of outbreak-associated risk factors.

Resources

Educational Materials

Vaccine Information Statements (VIS)

Vaccine Administration Resources

Community Partners

Community Clinic Resources and Forms

Communications