We Should Pay More Attention to Michigan’s Outbreak of Hepatitis A

chef in kitchen

Laura Power, MPH ’15

Clinical Assistant Professor of Epidemiology and Internal Medicine; Associate Program Director for the Preventive Medicine Residency

January 14, 2019

A brief interview with Dr. Laura Power about Michigan’s current Hepatitis A outbreak, one of the biggest outbreaks of hepatitis A we’ve ever had in the US, with well over 800 confirmed cases since summer 2016.

What is hepatitis A?

It’s a virus that can cause inflammation of the liver and can make people very sick.

How is it spread?

You have to ingest hepatitis A to contract it. It is a highly contagious disease spread from human to human through fecal-oral contact. Most commonly, people contract it from infected food or water. It can also be spread through direct human-to-human contact. Sometimes the hepatitis A virus can be found on surfaces like door knobs, but contracting hepatitis A this way is not a common scenario. It’s mostly about ingestion of infected food and water.

How would you know if you had contracted hepatitis A?

Symptoms can vary depending on your own health status and your age, so you might not have many symptoms at all. But you can have very acute symptoms, including fever, nausea, vomiting, abdominal pain, loss of appetite, and other flu-like symptoms, as well as jaundice.

Some of the danger is with people working with food and not knowing they’re contagious.

It can make you quite sick and in rare cases can be fatal. Really healthy people can have subclinical symptoms and could simply clear a hepatitis A infection without knowing they had it. Some of the danger here, then, is with people working with food and not knowing they’re contagious. It is not a chronic disease like hepatitis B and C, infections that are blood-borne and can last for weeks or months before resolving.

Can hepatitis A be prevented with a vaccine?

Yes, there is a vaccine for hepatitis A that you’d receive with two injections at least six months apart. Even a single dose of vaccine will help protect against infection. With two doses of the vaccine, most people will have long-term protection, and we’ve seen protection last up to ten years, though the exact length of effectiveness has not been established.

Vaccinations can be obtained at your doctor’s office or through your local health department.

Who is this vaccine recommended for and where can I get the vaccine?

It is recommended that all children get vaccinated at 12 through 23 months of age as part of their routine childcare vaccination schedule. In addition, hepatitis A vaccine is recommended for persons who are homeless, incarcerated, use injection and non-injection illegal drugs, and those who work with these populations (Michigan Department of Health and Human Services). Vaccine is also recommended for persons who have close contact, care for, or live with someone who has hepatitis A and persons who have sexual activities with someone who has hepatitis A. Men who have sex with men, travelers to countries with high or medium rates of hepatitis A, persons with chronic liver disease, and persons with clotting factor disorders should also get vaccinated. Vaccinations can be obtained at your doctor’s office or through your local health department.

How do health departments respond to a hepatitis A outbreak?

Whenever we have a confirmed case of hepatitis A, health departments gather information from the patients: What did you eat? Are you a food worker? When did you begin noticing symptoms? Who else might have been exposed? All that information goes into a surveillance system that helps them manage exposure and communicate with the public about prevention. Health departments also help by providing vaccines, including to persons without insurance, and by reaching out to communities to coordinate prevention efforts. You can have severe cases and some deaths, so it is definitely something we should be taking seriously.

ABOUT THE AUTHOR

Laura PowerLaura Power, MPH, MD, is Clinical Assistant Professor of Epidemiology in the School of Public Health and Clinical Assistant Professor of Internal Medicine in the Infectious Diseases Division at the School of Medicine. She is Associate Program Director for the Preventive Medicine Residency at the University of Michigan School of Public Health and an assistant editor for the American Journal of Preventive Medicine. She completed an internal medicine residency at Wayne State University in Detroit, followed by an infectious diseases fellowship at Beth Israel Deaconess Medical Center in Boston. She later completed a Preventive Medicine Residency at the University of Michigan School of Public Health. Prior to joining the University of Michigan, Dr. Power practiced at Henry Ford Health System as an infectious diseases physician, where she also served as Medical Director for Infection Prevention. Her research interests include vaccine-preventable diseases, communicable diseases epidemiology, infection prevention, and public health.

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