Hepatitis A vaccinations slowing state outbreak, health officials say

By CASEY HULL
Capital News Service

LANSING — Vaccination efforts by local health departments have helped reduce the hepatitis A outbreak in Michigan, officials say.

The outbreak that started in August 2016 infected 797 people across 32 counties and resulted in 25 deaths.

The hepatitis A virus is found in the feces of people with hepatitis A. It can be transmitted through contaminated food or water, sexual intercourse or living with an infected individual.

Symptoms include fever, yellowing of the skin and eyes, belly pain, loss of appetite, dark urine, joint pain, nausea and vomiting.

“When we started to see three, four or five cases consistently (in the summer of 2016), we knew we were dealing with something that looked like an outbreak and needed additional attention,” said Jay Fielder, the manager of the Department of Health and Human Services surveillance and infectious disease and epidemiology section.

An outbreak is an abnormal number of cases. The  department considers any county with two or more cases to be a part of the outbreak area.

The Legislature appropriated $7.1 million last November for the department to deal with hepatitis A, with $4 million earmarked to purchase vaccines and $3.1 million to local health departments for outreach and additional staffing. The majority of the funding went to the highest need districts. In March, each non-outbreak district received $20,000 dollars for preventative efforts.

“Even though we didn’t have any activity in our area at that time and we hadn’t received any funding, we began ramping up our activities,” Joshua Myerson said. He is the medical director for District Health Department 4, which covers Cheboygan, Montmorency, Alpena and Presque Isle counties, for the Benzie-Leelanau District Health Department and for  the Health District of Northwest Michigan.

“The health department provided notification and guidance to local area health providers,” he said. Providers were told to actively look for symptoms of hepatitis A.  

“It’s not something that we would typically think about because we don’t see many hepatitis cases in the area,” said Myerson.

The federal Centers for Disease Control and Prevention (CDC) regulates vaccine distribution to states. Health and Human Services pays the CDC $25.73 per dose, and local health departments then distribute the vaccine at little to no charge.

Over 117,000 doses have been provided in Michigan since the beginning of the outbreak.

The groups most susceptible to infection from hepatitis A are transient and homeless people, men who have sex with other men and substance abusers, according to Health and Human Services.

In the outbreak, 50.6 percent of confirmed cases in Michigan had a history of substance abuse, the department said.

“Part of what we did is reach out to our substance abuse treatment centers, like Harbor Hall in Petoskey,” Myerson said. “We’re hoping to use this additional funding to double back and see if there is anyone we missed.”

Some people are more difficult to reach than others.

Fielder said illiteracy and a lack of access to information sources that the general public receives makes messaging to homeless people difficult.

The vaccine can provide immunization for infected individuals within the first two weeks that they’re infected.

Meyerson said, “If we vaccinate you within 10 days of being exposed to the virus, that vaccine can provide you protection so you don’t get sick. A completed schedule of doses will provide lifetime protection.”

Hepatitis A has an incubation period of between 10 and 50 days.

During that time, an infected individual can spread the disease without showing any signs or symptoms.

Fielder said, “In all hepatitis cases, there is a follow-up by local health departments.”

The goal is to assess whether there’s a common source of the infection and to look at a patient’s potential exposure to family, roommates and workplaces, Fielder said.

“Identifying people who may have had contact with the patient is a very effective way of mitigating the spread of the virus,” Fielder said.

In 20 percent of cases reported during the  outbreak, local health departments were unable to follow up with patients.

“Some people don’t want to talk to the health department when they call and some people don’t necessarily give correct information when they seek health care, but the health department does try and initiate follow-up with every case,” Fielder said.

“People who are using substances that are illegal, they don’t necessarily want to be contacted and they don’t necessarily want to participate in a follow-up,” he said.

Creating a coordinated response across state agencies prompted the attorney general to activate the state emergency operations center.

“Given the impact upon multiple jurisdictions, this entire effort could benefit from coordination amongst the state agencies,” said Fielder.

“In this situation, there were seven state agencies involved in the response,” said Dale George, the public information officer for the state emergency operations center.

The goal of the operation center was to spread information to people at risk of the disease, along with food providers and first responders, Dale said.

“Every emergency or disaster begins and ends locally,” Dale said. “We’re here to make sure that communities get the help they need.”

Vaccination is also encouraged for people not considered to be at risk, Meyerson said. “For those who don’t fall in those risk groups but are concerned and want protection, there is no shortage of vaccine and they can get vaccinated.”