As of last week, Michigan officially has the deadliest of several hepatitis A outbreaks going on nationwide. Washtenaw County is one of multiple counties in southeast Michigan with an increased number of hepatitis A cases.
Outbreak in Southeast Michigan
As of Jan. 10, 2018, there have been 677 cases of hepatitis A diagnosed in Southeast Michigan since Aug. 2016. Of those reported cases, 554 required hospitalization and 22 resulted in death. In Washtenaw County, 13 cases have been identified since the outbreak began. One of those cases were reported in 2016, ten in 2017, and two already in 2018. Learn more about the Southeast Michigan outbreak at www.mi.gov/hepatitisaoutbreak.
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. 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.
No common sources of food, beverages, or drugs have been identified as a potential source of infection. Vaccination and good handwashing can help prevent the spread of illness. Vaccination is strongly recommended for anyone at increased risk of illness or who works in certain occupations where infection could spread to large numbers of people.
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 Southeast Michigan.
Jay Fiedler, MDHHS section manager for surveillance and infectious disease epidemiology says, “hepatitis A isn’t usually too serious for the average healthy person. We are seeing deaths more associated with people who have chronic liver conditions, or other conditions that make them more frail.”
Even though hepatitis A isn’t usually deadly, given the outbreak, MDHHS is encouraging people in high-risk categories such as people with substance abuse problems, people who have been incarcerated and people with underlying medical conditions, especially liver problems, to get vaccinated.
While Michigan’s outbreak has been linked to those higher-risk groups, it isn’t strongly tied to any one of them, and almost 40% of cases is made up of people with no known risk factors. There’s also no identified source for this outbreak.
Hepatitis A
Hepatitis A is caused by the hepatitis A virus, and it can cause damage to the liver and other health problems. Hepatitis A can range from a mild illness lasting a few weeks to a serious illness lasting several months.
Symptoms of hepatitis A include fatigue, poor appetite, stomach pain or tenderness, nausea or vomiting, dark urine, and yellowing of the skin (jaundice). Most children less than 6 years do not experience symptoms. Symptoms typically appear 2 to 6 weeks after exposure. Individuals with symptoms should call their provider or seek care.
How is it spread?
Washtenaw County is considered part of a larger, ongoing outbreak of hepatitis A in Southeast Michigan. Hepatitis A appears to be spreading through direct person-to-person contact or illicit drug use. Those with history of injection and non-injection drug use, homelessness, or incarceration are thought to be at greatest risk.
The virus is found in the feces of people with hepatitis A. Most infections result from contact with an infected household member or sex partners. The virus can also be spread by consuming food or drink that has been handled by someone with hepatitis A. It is not spread through coughs or sneezes. Someone who has hepatitis A can spread it to others for up to 2 weeks before symptoms appear.
Prevention
The best way to prevent hepatitis A is to get vaccinated. One dose is almost 95 percent effective at preventing infection, according to the Centers for Disease Control and Prevention (CDC). The hepatitis A vaccine is now routinely recommended for children at one year of age. Most adults, however, have not been vaccinated against hepatitis A.
Frequent handwashing with soap and warm water after using the bathroom and before handling food can also help prevent the spread of hepatitis A. Appropriately cooking foods can also help prevent infection. Freezing does not kill the virus.
Additional prevention strategies include using your own towels, toothbrushes, and eating utensils; not sharing food, drinks, or cigarettes; and not having sex with someone who has the hepatitis A virus.
Vaccination Strongly Encouraged
“We have an extremely effective hepatitis A vaccine, however, most adults haven’t received it,” says Jessie Kimbrough Marshall, MD, MPH, medical director with Washtenaw County Health Department. “We are working to offer it as quickly and as easily as possible, especially to those groups we’ve prioritized as being at increased risk of infection or transmission of the hepatitis A virus.”
Vaccination in Washtenaw County
Prior to the current outbreak, the average number of adult doses of hepatitis A vaccine given in Washtenaw County was about 90 per week. Since Oct 2017, that number has increased to over 370 doses per week for a total of more than 3,973 adult doses from Oct. 1, 2017 – Dec.10, 2017. (Data from Michigan Care Improvement Registry.)
Washtenaw County Health Department has given over 1,270 doses of hepatitis A vaccine since Oct. 1, 2017.
Washtenaw County Health Department is prioritizing vaccination for: People who use injection or non-injection illegal drugs; People currently homeless or in transient living; Male same sex partners; People incarcerated in correctional facilities; People who work with these higher risk groups, including health care providers and first responders; People who have close contact, care for, or live with someone who has hepatitis A; People with liver disease (such as hepatitis B, hepatitis C, or cirrhosis) or clotting factor disorders; People who prepare food for others, such as food service employees and restaurant workers.
Washtenaw County Health Department can provide hepatitis A vaccination to anyone without health insurance, with Medicaid, or who cannot get it elsewhere. Please call 734-544-6700 to schedule an appointment.
COST: There is no additional charge for the hepatitis A vaccine if you are among those prioritized for vaccination, are uninsured, or have Medicaid.
If you have private insurance, please check with your health care provider first. Washtenaw County Health Department can provide vaccination at no additional charge if you cannot get it elsewhere and are among those prioritized for vaccination.
