Public Health Hep-A prevention campaign sees success

Wednesday, March 20, 2019

Since 2016, the Centers for Disease Control and Prevention (CDC) have been assisting state and local health departments in eighteen states to deal with Hepatitis-A outbreaks that have sickened over 13,500 people and killed at least 119. To date there are ongoing Hepatitis-A outbreaks in fifteen states, twelve of which have resulted in 50% hospitalization rates, and CDC and has declared these the deadliest US Hepatitis-A this century.

Most of these outbreaks are concentrated primarily among persons who use injection and non-injection drugs, and persons who are homeless. However, a number of infections have occurred among people who provide housing and social services, as well as cases in restaurants where the risk of community-wide spread is much greater.

To date there have been no Oregon Hepatitis-A cases epidemiologically linked to any of the outbreaks around the country. Nevertheless, out of an abundance of caution and an ever-improving understanding of the risks facing our unhoused population, Benton County Health Department (BCHD) began a Hepatitis-A prevention campaign in late 2017. It is a classic public health campaign in the sense that it is designed to prevent an outbreak before the first case appears.

Health Department staff have worked to raise awareness of Hepatitis-A risks among the homeless and injection drug users. Similar outreach efforts have taken place among people who are at risk of homelessness, as well as to groups who provide services for the homeless.

BCHD procured special project Hepatitis-A vaccine from the Oregon Health Authority (OHA), and began vaccinating homeless individuals regardless of insurance status. Since fall 2017, BCHD has given 117 doses of Hepatitis-A vaccine to 114 individuals in the target populations at outreach sites such as shelters, drop-in centers, soup kitchens and public health clinics.   

Hepatitis-A Vaccine Recommendations

In October 2018, the CDC’s Advisory Committee on Immunization Practices (ACIP) unanimously voted to add homeless individuals to the list of those for whom Hepatitis-A vaccine is recommended. Also the CDC identified both injection and non-injection users as high-risk groups for Hepatitis-A infection who should be vaccinated (whether housed or not) due their increased risk of Hepatitis-A infection or severe Hepatitis-A disease.

The Role of Local Health Care Providers

The Health Department is calling on providers in our communities to help prevent the spread of national Hepatitis-A outbreaks to Benton County and Oregon by vaccinating those who are homeless or injecting drugs. In addition, providers should check the Hepatitis-A vaccination status of all patients who are food-service workers as well as those who volunteer or work with faith or community-based homeless assistance groups. 

BCHD entered information for all administered vaccinations into Oregon’s ALERT vaccination data system. To prevent duplication and help ensure insurance payment, check the vaccination status of clients in ALERT, and immediately enter every dose given into ALERT.

This is an opportunity for the entire health system to work together to create the headline: “This Year, No Hepatitis-A Outbreaks Happened.”