In a follow-up on the hepatitis A outbreak in Southeast Michigan, The Michigan Department of Health and Human Services (MDHHS) and local public health officials continue to investigate an outbreak of hepatitis A cases in the city of Detroit, and Macomb, Monroe, Oakland, Wayne, and St. Clair counties. As part of the ongoing investigation, public health officials have been working to make partners in these jurisdictions aware of the outbreak and the importance of vaccination and testing.

Image/Census Bureau
Image/Census Bureau

From August 1, 2016 to September 15, 2017, there have been 319 cases of confirmed hepatitis A including 14 deaths. Of these cases, nearly 86 percent have been hospitalized. This represents a sixteen-fold increase for these jurisdictions from August 1, 2014 to September 15, 2015.

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On September 18, the state Medicaid program issued a letter to healthcare providers about the outbreak, testing information, including prevention, testing, and treatment information. This letter was sent to 5,069 Medicaid-enrolled providers in Detroit, and Macomb, Oakland, St. Clair, and Wayne counties, as well as another 11,758 providers and interested parties signed up for Medicaid updates. In addition to this provider outreach, public health officials have been working to increase vaccination in at-risk populations. These activities include:

  • There are ongoing vaccination campaigns in Macomb, Oakland, St. Clair, and Wayne jails, substance use treatment centers, and homeless centers, as well as discussion with the Michigan Department of Corrections about implementing a vaccination campaign in the Detroit Receiving Center and Detroit Detention Center.
  • MDHHS is working with Detroit Health Department and regional Emergency Departments to implement a vaccination campaign targeting at-risk patients.
  • Supported by contracted nurses from the Visiting Nurse Association, MI Volunteer Registry volunteers, and MDHHS, local health departments are partnering with community organizations to provide hepatitis A vaccine to at-risk individuals.
  • Oakland County has dedicated resources to offer vaccinations to all employees and ongoing outreach activities to at risk individuals.

Ages of the cases range from 20 to 87 years, with a median age of 42.5 years, and two-thirds of the cases (64 percent) are men. While no common source of the outbreak such as contaminated food or water has been identified, transmission does appear to be person-to-person through illicit drug use, sexual activity, and close contact among household members.

The ongoing hepatitis A outbreak presents a significant public health threat to vulnerable community members within Southeast Michigan. Over half of the cases (51 percent) have a history of substance abuse, 28 percent are co-infected with hepatitis C, 15 percent are homeless/in transient housing situations, and nineteen cases (6.4 percent) have a history of recent incarceration.

“The Southeast Michigan hepatitis A outbreak remains a top priority for public health officials from both the investigation and prevention standpoints,” said Dr. Eden Wells, chief medical executive for MDHHS. “Hepatitis A is a vaccine-preventable disease and in addition to our investigation of current and new cases, our focus is strongly aimed at increasing vaccination in adults, where hepatitis A vaccination is commonly low.”

Vaccination is recommended for the following at–risk individuals:

  • Health care workers who have direct contact with patients
  • People who use injection and non-injection illegal drugs
  • People who participate in commercial exchange of sexual practices
  • People who are homeless or in transient living situations
  • People who are or have recently been incarcerated
  • Close personal contacts (e.g., household, sexual) of hepatitis A patients
  • Food handlers
  • Men who have sex with men
  • People with liver diseases, such as hepatitis B or hepatitis C. Persons with chronic liver disease have an elevated risk of death from liver failure.
  • Any person who wishes to be immune to hepatitis A
  • People who live, work, or recreate in SE Michigan and are concerned about getting hepatitis A

Individuals with hepatitis A are infectious for two weeks prior to symptom onset. Symptoms of hepatitis A include jaundice (yellowing of the skin), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools. Symptoms usually appear over a number of days and last less than two months; however, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and death.

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Risk factors for a hepatitis A infection include living with someone who has hepatitis A, having sexual contact with someone who has hepatitis A, or sharing injection or non-injection illegal drugs with someone who has hepatitis A. The virus can also be transmitted through contaminated food or water.

Together with local health departments, MDHHS urges those individuals at greatest risk to seek hepatitis A vaccination at the locations below. Residents in the city of Detroit and Macomb, Monroe, Oakland, St. Clair, and Wayne counties should talk to their healthcare provider about their risks.

Contact your local health department about how to receive the hepatitis A vaccine:

  • Detroit Health Department, 313-876-4000
  • Macomb County Health Department, 586-469-5372
  • Monroe County Health Department, 1-888-354-5500, Ext. 7800
  • Oakland County Health Division, 1-800-848-5533 or email [email protected]
  • Clair County Health Department, 810-987-5300
  • Wayne County Communicable Disease Unit, 734-727-7078