UPDATES FOR MMDHD JENNIFER MORSE, MD 1/24/18

Transcription

1 UPDATES FOR MMDHD JENNIFER MORSE, MD 1/24/18

2 HEPATITIS A

3 WHAT IS HEPATITIS A? Virus that causes liver disease (hepatitis) Spreads in feces (stool) (UNLIKE hepatitis B and C that are spread in blood) Contaminated stool (from unwashed hands, other items) gets on food, drinks, objects then then go into the mouth Once in the body, it takes an average of 28 days (range 15 to 50 days) before illness appear Once ill, usually sick for less than 2 months; about 1 in 10 will be sick for up to 6 months Hepatitis A will not become chronic (or lifelong) like hepatitis B and C Can lead to liver failure, need for liver transplant, and death Most older children and adults have symptoms Most children under the age of 6 don t have symptoms but are still contagious

4 WHAT IS HEPATITIS A? Symptoms of hepatitis A are: Fever Tiredness Loss of appetite Nausea Vomiting Belly pain Joint pain Jaundice (yellowing of the skin and eyes), and dark urine (looks like Coca Cola) and/or clay-colored bowl movements (due to the jaundice)

5 WHAT IS HEPATITIS A? Infected people are most contagious the 1 to 2 weeks BEFORE symptoms start and continue to be infectious for up to a week after the start of jaundice or other symptoms. Hepatitis A virus can live outside the body for months Hep A on/in foods: heating to 185 or higher for 1 minute kills virus; freezing DOES NOT kill the virus Chlorination of water kills the virus (so contamination of water in developed countries is rare) Disinfection of surfaces is similar to other viruses (see handout available on

6 Nationwide Outbreaks of Hepatitis A Multiple outbreaks in US since July 2016 California: 688 cases (as of 1/12/18): most cases in San Diego County Utah: 154 cases (as of 1/22/18) Kentucky: 70 cases (as of 1/18/18) Michigan: 692 cases (as of 1/17/18): largest person-to-person outbreak since vaccine available in1996 (surpassed California) Average number of HAV cases in Michigan approx. 87/year 2017: 699 cases in Michigan AN INCREASE OF 8x ABOVE AVERAGE All of the above outbreaks primarily involve a genotype (strain) not often seen in North America called 1b

7 1996: Hepatitis A vaccination recommended for those at high risk 1999: vaccination recommended for all children living in states with high rates In 2006, routine vaccination of all children in all states was recommended and is still recommended One dose of vaccine is at least 95% effective; 2 doses nearly 100% effective START OF CURRENT OUTBREAKS

8 Who is at increased risk of getting hepatitis A? Persons who use injection and non-injection illegal drugs Persons who are homeless or transient Persons who are incarcerated Men who have sex with men (MSM) Persons who work with or have a lot of contact with the high risk populations listed above Persons who have close contact, or lives with someone who has hepatitis A Travelers to countries with high or medium rates of hepatitis A or those living with recent adoptees from high/medium risk countries People with clotting factor disorders (hemophiliacs) due to prior outbreaks linked to their treatment

9 MICHIGAN OUTBREAK STATISTICS Confirmed Cases Referred August 1, 2016-January 17, 2018 Meeting the SE MI Hepatitis A Outbreak Case Definition County (or city) Total Cases County (or city) Total Cases Macomb 199 Grand Traverse 4 City of Detroit 154 Shiawassee 3 Wayne 121 Calhoun 3 Oakland 94 Clare 1 St. Clair 27 Clinton 1 Washtenaw 15 Eaton 1 Monroe 14 Hillsdale 1 Ingham 13 Huron 1 Genesee 10 Ionia 1 Isabella 8 Kent 1 Livingston 6 Leelanau 1 Sanilac 6 Van Buren 1 Lapeer 5 Other* 1 *Jackson Michigan Department of Corrections Indicates counties with outbreak-associated cases that are not included in the outbreak jurisdiction Total Outbreak Cases as of 1/17/18 = 692 Main Risk Factors (may have more than one): Substance Abuse: 48.6% MSM: 14.3% Homeless/Transient Living: 11.8% Correctional Facility inmates: 7.7% Co-infected with Hep C: 28% Healthcare worker: 2.9% Food Worker 4.3% Hospitalization Rate: 81.5% Death Rate: 3.2% (22 deaths total)

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11 MMDHD CASE COUNTS FROM MMDHD have average of 0 to 3 HAV cases/year 2016: zero cases 2017: 2 cases 2018: 3 cases to date One case confirmed by genotype testing to be linked to outbreak (Clinton) Risk factor = drug use Two cases (Clinton and Gratiot) with genotyping pending One with no obvious risks One with travel to Detroit

12 CURRENT PRIORITIES OF MMDHD Educate the community to watch for individuals with signs of hepatitis A Continue to vaccinate high risk groups Persons who use injection and non-injection illegal drugs Persons who are homeless or transient Persons who are incarcerated Men who have sex with men (MSM) Persons who have close contact, care for, have sexual activities, or live with someone who has hepatitis A or has high risk factors for hepatitis A Food service workers: Not at increased risk of infection due to their job, but if they do get hepatitis A it could potentially cause many cases. Vaccination is being recommended in outbreak counties. Healthcare workers: Do not have increased rates of hepatitis A infection if routine infection-control precautions are followed. Vaccination is being recommended in outbreak counties, particularly in those with high-exposure jobs.

13 INFLUENZA

14 INFLUENZA SEASON Every year we experience a flu epidemic CDC now referring to current season as moderate to severe More providers are testing for influenza which may confound the data Between October 2017 to January 13, 2018: 30 children have died in U.S. due to influenza Influenza A H3N2 is currently predominate strain Tend to have worse flu season when H3 predominates, with more hospitalizations and deaths H3N2 was dominant and Tend to see lower vaccine effectiveness against H3H2 (typically 30% effective); harder to create vaccine for this virus Likely many more weeks before flu activity slows down No signs of shift/drift of virus or resistance to antiviral medication

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20 INFLUENZA HOSPITALIZATION SURVEILLANCE Clinton, Eaton, Ingham, Genesee*, Washtenaw** Counties *added **added

21 INFLUENZA POSITIVE TEST RESULTS, MDHHS LABS,

22 CONGREGATE SETTING OUTBREAKS OF VIRAL RESPIRATORY ILLNESS

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