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News & Press: MPCA News

Hepatitis A Outbreak Requires Coordinated Attack

Tuesday, November 21, 2017   (0 Comments)
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by Loretta V. Bush, MSHA, CEO


Southeast Michigan has been rocked by an explosion of hepatitis A (HAV) infections, and the outbreak has officially spread into Huron, Ingham, Lapeer, Livingston, Macomb, Monroe, Oakland, Sanilac, St. Clair, Washtenaw, and Wayne counties. 

Since August 2016, there’ve been more than 495 cases, a massive increase over previous years in which the Detroit Health Department might record only one or two cases per month. The virus, which attacks the liver, can cause flu-like symptoms, liver damage, and other health issues, and it’s almost always serious. Eighty-four percent of the people who’ve gotten sick have been hospitalized, and 19 have died. To make treating and preventing the illness more complicated, symptoms may not manifest until two to six weeks after exposure. That leaves plenty of time for infected individuals to expose others before they even know that they’re ill.

Fortunately, education and vaccination are excellent prevention measures.

We know that some people carry additional risk factors for acquiring the disease, including people with a history of substance use, people who are homeless or in transient living, men who have sex with men, incarcerated individuals, food handlers, health care workers, and people with underlying liver disease. The challenge is identifying them.

That’s why universally screening patients for HAV risk factors is so important, especially at Michigan’s health centers. “This is an all hands on deck situation,” said Dr. Joneigh S. Khaldun, Executive Director and Health Officer for the Detroit Health Department. “Health centers have a major part to play in curbing this outbreak. They are seeing some of our most vulnerable patients, which puts them on the front lines.”

In Detroit, 50 percent of HAV cases are in individuals who are on Medicaid, a population to whom health centers overwhelmingly provide care. If a health center can identify an individual at risk (or a patient who simply wants to take preventive measures), they can offer vaccination. Universal screening also gives providers the opportunity to assess whether they believe a patient may have been exposed. If so, they have a 14-day window in which to vaccinate and have that vaccination be effective in preventing the disease. And for older or immunocompromised individuals, a second injection can provide additional protection.

You may be wondering why so many people are getting sick if a safe and effective vaccine exists. The HAV vaccine didn’t become a part of the routine childhood immunization schedule until 1994. As a result, many older adults haven’t been vaccinated, leaving them susceptible to illness. Only 13 percent of Michigan adults have received the HAV vaccine. For people over 40, the vaccination rate drops to less than 5 percent. When you consider that the average age of individuals who’ve contracted HAV since August 2016 is 42 years old, that’s a serious problem.

The more people we vaccinate, the more people we can prevent from getting sick. That’s called “herd immunity.” Herd immunity is how we’ve managed to protect most of the world from diseases such as measles, whooping cough, and polio. Once a large percentage of the population is effectively immune to an infection (through vaccination), it makes it harder for that infection to move through a community. Chains of transmission are broken. The probability that someone who is not immune will come into contact with an infectious individual goes way, way down.

There’s no good reason not to get on board. Federally Qualified Health Centers that are members of the Vaccines for Children Program or the Vaccine Replacement Program can deliver vaccinations to the uninsured and still receive coverage. They can also refer uninsured individuals to their local health department, which can also provide no-cost vaccinations. 

But beyond increasing vaccination rates, there are also two more important pieces of the prevention puzzle: proper hand hygiene and bathroom cleaning. Hepatitis A enters the body through a fecal-oral transmission route — and it can survive on surfaces for weeks. That makes thoroughly cleaning hands on a regular basis and using bleach to clean bathroom surfaces key components in disrupting transmission and helping prevent infection.

The Detroit Health Department is already responding by providing targeted vaccination efforts at homeless shelters, adult foster care homes, nursing homes, and rehabilitation centers, but strongly recommends broader vaccination efforts — especially for health care workers who come in direct contact with patients. It’s also important to remind patients that even if they don’t know whether they’ve had the vaccine before, it’s perfectly safe to get it again.

Health centers are encouraged to report any suspected cases within 12 hours of discovery to the Detroit Health Department by calling 313.876.4000. You can also find out more at

Dr. Khaldun said it best: “We all have to come together to get ahead of this outbreak.”

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