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
Webinar Overview Hepatitis A Facilitated Introduction Discussion 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 on 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 of 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.
Who Should Be Vaccinated With Hepatitis A Vaccine? • 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 cont’d. • 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
What Are the Hepatitis A Vaccines? • Monovalent hepatitis A – Havrix – Vaqta • Combination hepatitis A/B – Twinrix – Licensed for persons aged 18 and older
What is the Hepatitis A Vaccine Schedule? Havrix 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 Vaqta 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
What is the Hepatitis A/B Vaccine Schedule? Twinrix 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 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.
Hepatitis A Outbreak States https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm
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
Facilitated Discussion Overview MODULE ONE MODULE TWO MODULE THREE At-Risk Potential Prevention Framework Populations Partners
MODULE ONE AT-RISK POPULATIONS
Identifying At-Risk Populations Pause t the r recor ording ng. Work o on page three i in the r roadmap.
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
Identifying Potential Partners Pause t the r recor ording ng. Work on pages f four and nd f five in n the r roadmap.
MODULE THREE PREVENTION FRAMEWORK
Hepatitis A Outbreak Prevention Framework Overview 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?
Role of the Department of Health Services 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.
Outbreak Prevention Framework Development Pause t the r recor ording ng. Work on pages 6 6–8 i 8 in t n the roadmap.
NEXT STEPS
Next Steps At Local Level 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 State 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 • occurs.
THANK YOU ALL FOR PARTICIPATING! Susann Ahrabi-Fard Epidemiologist Bureau of Communicable Diseases susann.ahrabiard@wisconsin.gov Stephanie Borchardt Epidemiologist Bureau of Communicable Diseases stephanie.borchardt@wisconsin.gov Svea Erlandson Training and Exercise Coordinator Office of Preparedness and Emergency Health Care charlotte.erlandson@wisconsin.gov
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