Hepatitis A Outbreak Summit March 13, 2019 1 - 2:30 pm: Clinical - - PowerPoint PPT Presentation

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Hepatitis A Outbreak Summit March 13, 2019 1 - 2:30 pm: Clinical - - PowerPoint PPT Presentation

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3/13/2019 1 Hepatitis A Outbreak Summit March 13, 2019 1 - 2:30 pm: Clinical 3 - 4pm: Community Services 3/13/2019 2 Clinical Session Agenda Welcome and Introduction Paula Mandel, PCHD Deputy Director 5 minutes Local Hepatitis

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Hepatitis A Outbreak Summit

March 13, 2019 1 - 2:30 pm: Clinical 3 - 4pm: Community Services

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A Healthy Pima County. Everyone. Everywhere. Everyday.

  • Welcome and Introduction – Paula Mandel, PCHD Deputy Director

5 minutes

  • Local Hepatitis A Outbreak – Mary Derby, Ph.D., Epidemiology Program Manager

15 minutes

  • Clinical Interventions – Kristin Robinson-Lund, Nurse Manager

15 minutes

  • Sanitation Interventions – David Ludwig, Consumer Health and Food Safety

Manager 10 minutes

  • Roundtable Discussion – Mark Person, Community Mental Health & Addiction Program

Manager 45 minutes

Clinical Session Agenda

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  • Welcome and Introduction – Paula Mandel, PCHD Deputy Director

5 minutes

  • Local Hepatitis A Outbreak – Mary Derby, Ph.D., Epidemiology Program

Manager 15 minutes

  • Sanitation Interventions – David Ludwig, Consumer Health and Food Safety

Manager 10 minutes

  • Roundtable Discussion – Gary Frucci, Environmental Health Supervisor

30 minutes

Community Services Session Agenda

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Welcome and Introduction

Paula Mandel PCHD Deputy Director

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Local Hepatitis A Outbreak

Mary Derby, Ph.D., Epidemiology Program Manager

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Hepatitis A Overview

  • Viral infection
  • Vaccine-preventable
  • (case reduction since 1996 when vaccine

made available)

  • Treatment: supportive
  • Transmission: fecal-oral
  • Incubation period: 28-30 days (range

15-50)

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Hepatitis A Overview

  • Symptoms: fever, anorexia,

malaise, nausea, vomiting, diarrhea, abdominal pain, jaundice, dark urine.

  • Duration: typically several

weeks (up to several months)

  • Can be asymptomatic,

especially in children

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Role of PCHD Epidemiology

  • Receive suspect and positive laboratory reports:
  • Providers: within 1 working day suspect or confirmed case
  • Laboratories: within 1 working day for positive results, submit

disease panel results

  • Interview cases:
  • Incubation period: where/how they could have been infected
  • Contagious period: potential close contacts that could have been

infected

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Role of PCHD Epidemiology

  • Implement prevention and

control measures:

  • Provide education to case and

close contacts

  • Recommend Post Exposure

Prophylaxis (PEP) to contacts within 14 days of exposure

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Who is at increased risk of contracting hepatitis A?

  • People with direct contact with someone with hepatitis A
  • Travelers to countries where hepatitis A is common
  • People who are experiencing homelessness
  • Men who have sex with men (MSM)
  • People who use drugs, both injection and non-injection drugs
  • Household members or caregivers of a recent adoptee from countries

where hepatitis A is common

  • People with clotting factor disorders such as hemophilia
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A Healthy Pima County. Everyone. Everywhere. Everyday. Tool created by Dr. Bethany Bruzzi and Kathleen McCasland, MT, MBA for BUMC South

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5 10 15 20

Outbreak/ Potential Hepatitis A Cases

Pima County Outbreak (Nov 2018 – Feb 2019)

Number of outbreak cases by collection date Number of investigated cases by notification date

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A Healthy Pima County. Everyone. Everywhere. Everyday. Pima County Hepatitis A Cases by Year

2013 8 2014 5 2015 12 2016 13 2017 5 2018 58 2019 YTD 89

Hepatitis A Trends

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Resources

Mary Derby Mary.Derby@pima.gov Pima County Epidemiology Phone Line 520-724-7797 www.pima.gov/hep-a www.cdc.gov/hepatitis/hav/index.htm

www.pima.gov/health

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Clinical Interventions

Kristin Robinson-Lund Nurse Manager, North Clinic

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Target and risk populations

Individuals who are experiencing:

  • Homelessness
  • Illicit drug use

Common exposure areas:

  • Substance rehabilitation facilities
  • Pima County Adult Detention Center
  • Homeless shelters
  • Public parks and areas
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Post-exposure prophylaxis recommendations:

Indication/Age group Risk category/Health status Hepatitis A vaccine Immune globulin <12 mos Healthy No 0.1 mL/kg* 12 mos–40 yrs Healthy 1 dose† None >40 yrs Healthy 1 dose† 0.1 mL/kg§ ≥12 mos Immunocompromised

  • r chronic liver

disease 1 dose† 0.1 mL/kg¶ ≥12 mos Vaccine contraindicated** No 0.1 mL/kg

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Pre-exposure protection recommendations:

Indication/Age group Risk category/Health status Hepatitis A vaccine Immune globulin <6 mos Healthy No 0.1–0.2 mL/kg§§ 6–11 mos Healthy 1 dose¶¶ None 12 mos–40 yrs Healthy 1 dose*** None >40 yrs Healthy 1 dose*** 0.1–0.2 mL/kg§§,††† All ages Immunocompromised

  • r chronic liver

disease 1 dose*** 0.1–0.2 mL/kg§§,††† >6 mos Persons who elect not to receive vaccine or for whom vaccine is contraindicated** No 0.1–0.2 mL/kg§§

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Recommendation caveats

  • † A second dose is not required for post exposure prophylaxis; however, for

long-term immunity, the hepatitis A vaccination series should be completed with a second dose at least 6 months after the first dose.

  • § The provider’s risk assessment should determine the need for immune

globulin administration. If the provider’s risk assessment determines that both vaccine and immune globulin are warranted, Hep A vaccine and immune globulin should be administered simultaneously at different anatomic sites

  • ¶ Vaccine and immune globulin should be administered simultaneously at

different anatomic sites. For more, visit: https://www.cdc.gov/mmwr/volumes/67/wr/mm6743a5.htm?s_cid=mm6 743a5_w

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PCHD Community-Based Outreach and Prevention Response:

  • Hepatitis A vaccination outreach

clinics at partner locations

  • Mobile clinics targeting public

parks and areas where cases have been identified

  • Environmental sanitation

assessment

  • Education in clinics
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Ways you can protect your clients:

Education

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Ways you can protect your clients:

Intake screening and referral

  • Arizona State Immunization

Information System (ASIIS) Vaccination

  • Host a PCHD clinic or offer

vaccine

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Sanitation Interventions

David Ludwig Consumer Health and Food Safety Manager

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  • Providing hepatitis A prevention

education to food permit holders

  • Investigating suspected hepatitis A

foodborne cases

  • Conducting on-site environmental

assessments in facilities associated with person confirmed to have hepatitis A

PCHD Consumer Health and Food Safety Efforts

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A Healthy Pima County. Everyone. Everywhere. Everyday. Handouts are being distributed to all food

  • perations.
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Ways to prevent the spread of hepatitis A

Staff protection

  • Food handlers, sanitation

workers, and other professionals directly serving high risk individuals are recommended to receive the hepatitis A vaccine

  • Use appropriate standard

precautions – proper handwashing, gloves

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Ways to prevent the spread of hepatitis A

Augment sanitation

  • Use disinfectant products and

procedures that are effective against hepatitis A

  • Chlorine bleach at 5000ppm (1 +

2/3 cups bleach in 1 gallon water)

  • Always use in a well ventilated

space

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Ways to prevent the spread of hepatitis A

Prevention Education and Resources

  • Promote handwashing and

sanitation

  • Distribute information and

hygiene kits

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Education Materials

  • Hepatitis A: Cleaning and Disinfection Guidance
  • Protect Yourself From hepatitis A
  • Wash Your Hands
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Resources

David Ludwig David.Ludwig@pima.gov Gary Frucci Gary.Frucci@pima.gov Pima County Epidemiology Phone Line 520-724-7797 www.pima.gov/hep-a www.cdc.gov/hepatitis/hav/index.htm

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Roundtable Discussion

Mark Person Community Mental Health & Addiction Program Manager

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Thank you!