Preparing Wisconsin for Hepatitis A Bureau of Communicable Disease - - PowerPoint PPT Presentation

A Roadmap ap t to Outbreak ak R Resil ilie ience:

Preparing Wisconsin for Hepatitis A

Bureau of Communicable Disease Wisconsin Department of Health Services

Introduction Hepatitis A Overview Facilitated Discussion Webinar Overview

A Roadmap ap t to Outbreak ak R Resil ilie ience

INTRODUCTION

Why are we here?

Purpose: To encourage prevention activities for Hepatitis A on the local level, and strategies for doing so. Objectives:

• To assess the at-risk population in the jurisdiction.
• To begin identifying partners that can support

prevention activities.

• To identify preparedness activities that the

jurisdiction can engage in to prevent an outbreak.

A R Roadmap ap to O Outbreak ak Resil ilie ience

HEPATITIS A OVERVIEW

What is Hepatitis A? Hepatitis A (HAV) is a contagious infection of the liver caused by the hepatitis A virus.

Transmission occurs through:

• Ingestion of contaminated food or water.
• Touching contaminated objects.
• Close personal contact.

Who is at Risk for Hepatitis A?

*

• People in contact with others who have

hepatitis A

• Travelers to countries where HAV is

common

• People who use recreational drugs
• People experiencing homelessness

*

Who is at Risk for Hepatitis A? cont’d.

• Family or caregivers of adoptees from

countries where HAV infection is common

• Men who have sex with men
• People with chronic liver disease or

clotting factor disorders, such as hemophilia

How is Hepatitis A Virus (HAV) Transmitted?

• Symptoms begin around four weeks after exposure

but can range from two to seven weeks after exposure.

• A person is “infectious” and can spread the virus from

two weeks before their illness onset through one week after the onset of jaundice or elevation of liver enzymes.

How is Hepatitis A Virus (HAV) Transmitted? cont’d.

• HAV can live outside of the

body for months depending

• n the environmental

conditions.

• Children often don’t have

symptoms of HAV when infected but can still spread the virus.

Hepatitis A Diagnosis and Treatment

• A person is diagnosed by

their symptoms and results

• f a blood test.
• There is no medicine to

treat HAV.

• Rest, adequate nutrition,

and fluids may help recovery.

• A small percent of patients

may need hospitalization.

• All children at age 1 year
• People in direct contact to others with HAV infection
• Travelers to countries where HAV is common
• Users of drugs, whether injected or not
• Family and caregivers of adoptees from countries

where HAV is common

Who Should Be Vaccinated With Hepatitis A Vaccine?

• Men who have sex with other men
• Persons experiencing homelessness, transient, or

unstable housing

• Persons with clotting-factor disorders
• Persons with chronic liver disease, including from

chronic hepatitis B or C virus infection

Who Should Be Vaccinated With Hepatitis A Vaccine cont’d.

What Are the Hepatitis A Vaccines?

• Monovalent hepatitis A

– Havrix – Vaqta

• Combination hepatitis A/B

– Twinrix – Licensed for persons aged 18 and older

Age Volume

• No. Doses

Schedule 12 months–18 years 0.5 mL 2 0, 6–12 months ≥19 years 1.0 mL 2 0, 6–12 months

Havrix

Age Volume

• No. Doses

Schedule 12 months–18 years 0.5 mL 2 0, 6–18 months ≥19 years 1.0 mL 2 0, 6–18 months

Vaqta What is the Hepatitis A Vaccine Schedule?

Age Volume

• No. Doses

Schedule ≥18 years 1.0 mL 3 0, 1, 6 months ≥18 years 1.0 mL 4 0, 7 days, 21–30 days, 12 months

What is the Hepatitis A/B Vaccine Schedule? Twinrix

What is Hepatitis A Vaccine Efficacy?

• More than 95% of adults develop protective antibody

within four weeks of a single dose of monovalent hepatitis A vaccine.

• Nearly 100% seroconvert after two doses.

A R Roadmap ap to O Outbreak ak Resil ilie ience

CURRENT OUTBREAK

Summary

• Since the first hepatitis A outbreaks were first

identified in 2016, more than 15,000 cases and 8,500 (57%) hospitalizations have been reported.

• Hospitalization rates have been higher than typically

associated with HAV infection.

• Severe complications have also been reported,

sometimes leading to liver transplantation or death.

• At least 140 deaths have occurred nationwide.

https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm

Hepatitis A Outbreak States

California

• The Hepatitis A outbreak began in

San Diego county, November 2016.

• The majority of cases were among

persons experiencing homelessness and/or using illicit drugs in settings of limited sanitation.

• In total, there were 708 cases of hepatitis A, 465

(66%) people were hospitalized, and 21 people (3%) died.

• Approximately 123,000 vaccine doses were

distributed to local health departments.

Michigan

• A hepatitis A outbreak was identified in southeast

Michigan during August 2016.

• Persons with history of injection and non-injection

drug use, homelessness or transient housing, and incarceration were found to have the greater risk.

• There were 913 cases, 733 (80%) hospitalizations,

and 28 (3%) deaths associated with the outbreak.

Kentucky

• An outbreak of hepatitis A was identified in the

Jefferson County/Louisville area during November 2017.

• Similar to hepatitis A outbreaks in other states, the

primary risk factors were identified as illicit drug use and homelessness.

• There were 4,594 cases, 2,222 (48%) hospitalizations,

and 53 (1%) deaths associated with the outbreak.

Kentucky Hepatitis A Outbreak

https://chfs.ky.gov/agencies/dph/dehp/idb/Hep%20A%20Documents/Ac ute%20Hepatitis%20A%20Outbreak%20Week%2052%20Report.pdf

What is the Potential Impact in Wisconsin?

• Mass vaccination to contain an outbreak is time

consuming and expensive.

• Tailored, comprehensive public health interventions

will be needed to reach the at-risk populations.

• High hospitalization and mortality rates should be

anticipated.

• An ongoing outbreak will take time and efforts away

from other public health emergencies.

• Ongoing outbreaks can have financial impact on

businesses and tourism.

A R Roadmap ap to O Outbreak ak Resil ilie ience

FACILITATED DISCUSSION

Objectives

• Assess at-risk

populations within your jurisdiction.

• Assess internal and

external partners that could support prevention activities.

• Create a Hepatitis A

Outbreak Prevention Framework.

Facilitated Discussion Introduction Discussion guidelines Roadmap introduction Discussion structure

MODULE ONE At-Risk Populations MODULE TWO Potential Partners MODULE THREE Prevention Framework Facilitated Discussion Overview

MODULE ONE

AT-RISK POPULATIONS

Pause t the r recor

• rding

ng. Work o

• n page three i

in the r roadmap.

Identifying At-Risk Populations

MODULE TWO

POTENTIAL PARTNERS

The relationships built through preparedness and disease surveillance will be many of the same you lean on during a response.

34

Pause t the r recor

• rding

ng. Work on pages f four and nd f five in n the r roadmap.

Identifying Potential Partners

MODULE THREE

PREVENTION FRAMEWORK

• How will sufficient vaccine be acquired?
• Who will need to be vaccinated and how will they

be reached?

• Who will reach those that need to be vaccinated?
• What resources will be required to support

prevention activities?

• What else needs to be taken into consideration

when planning?

Hepatitis A Outbreak Prevention Framework Overview

Pre-Outbreak:

• Assist in estimating at-risk populations.
• Provide guidance on partnerships for

vaccination.

• Supply educational materials.
• Communicate regarding risk groups, vaccine

recommendations, etc. During Outbreak: Provide situational updates and guidance.

Role of the Department of Health Services

Pause t the r recor

• rding

ng. Work on pages 6 6–8 i 8 in t n the roadmap.

Outbreak Prevention Framework Development

NEXT

STEPS

• Complete the Hepatitis A Outbreak Prevention

Framework.

• Join the follow-up webinar on September 4, 2019.
• Begin working on the actions included in your

framework!

Next Steps At Local Level

• Host the follow-up webinar on September

4, 2019.

• Be available to provide guidance to local

public health on preparedness and prevention activities.

• Provide situational updates if an outbreak
• ccurs.

Next Steps at State Level

THANK YOU ALL FOR PARTICIPATING!

Svea Erlandson

Training and Exercise Coordinator Office of Preparedness and Emergency Health Care charlotte.erlandson@wisconsin.gov

Susann Ahrabi-Fard

Epidemiologist Bureau of Communicable Diseases susann.ahrabiard@wisconsin.gov

Stephanie Borchardt

Epidemiologist Bureau of Communicable Diseases stephanie.borchardt@wisconsin.gov