DETROIT – The largest hepatitis A outbreak in Michigan history continues to bring the disease into the headlines.
Hepatitis means inflammation of the liver and can be caused by a variety of sources, from toxins to immune problems. The five viruses, designated by the letters A through E are the most common causes. Hepatitis A is especially contagious.
Laura Bauman is the director of epidemiology for Washtenaw County, she points out that, “this is not an outbreak in kids.”
A vaccine has been available since 1995 and has been part of the childhood vaccine schedule since 1996.
Young adults and children who were vaccinated are extremely well protected. The hepatitis A vaccine is so effective that if an unvaccinated adult is exposed and receives the vaccine within two weeks they will be protected from infection.
Hepatitis A can be spread through blood exposure like hepatitis B, but that’s not the most common route of transmission.
“The bottom line is this is spread through poop,” Bauman said.
Hepatitis A is spread easily in areas with poor hygiene. The best defense, besides vaccination, is hand washing with soap and water.
Symptoms
- Fever.
- Fatigue.
- Yellowing of the eyes or skin from jaundice.
- Dark urine.
- Abdominal pain.
- Yellowing of the eyes or skin from jaundice, dark urine, and abdominal pain.
The incubation period is as short as two weeks but can be as long as two months. This long period between exposure and symptoms is especially problematic when it comes to tracking the source of an infection.
The current epidemic has been going on since 2016.
Dr. Joneigh Khaldun, director of the Detroit health department, notes, “we have not been able to identify where the source of the outbreak is.”
The entire state of Michigan has seen cases, but southeast Michigan, because of its population density, has been especially hard hit.
Dr Kevin Lokar, medical director of the Macomb County Health Department said, “as a health jurisdiction we do have the highest number as a geographic county.”
Nonetheless, he points out that, “our proportion of cases is parallel to what’s going on in the state.”
To date, across the state, there have been 910 cases, 80 percent have required hospitalization and 3.1 percent of patients have died.
Dr. Russel Faust, medical director of the Oakland County Health Department noted, “we’ve had five deaths, approximately four percent, so this is not an insignificant disease or infection.”
Hepatitis A can affect any unvaccinated person but the groups that have been most affected in this outbreak have been a special challenge to reach.
“Groups at risk have been those incarcerated, either in jails or the state prison system,” Lokar said.
“People that use drugs are at greater risk, men who have sex with men,” Faust said.
"People who struggle with transient housing (are at greater risk)," Khaldun said.
That has required some unique approaches to getting people vaccinated.
Depending on the county, vaccine distribution efforts have included emergency departments, bars, correctional facilities, and homeless encampments. There has also been a very high level of cooperation between national, state, and county health departments.
"We were having conference calls every other week, some of them were exclusively for southeast Michigan,” Lokar said.
All these efforts have seen results, the number of new cases has been on the decline and hopefully this outbreak will see an end.
Despite the challenges it has brought, it has helped forge new relationships between counties and other local partners.
“We’ve built some relationships with a lot of community partners that I think will help us in the future,” Lokar said.
The most important message all public health officials echoed is that the hepatitis A vaccine is your best defense and all unvaccinated individuals should get themselves vaccinated.
Watch part two of the report below: