Hepatitis A Outbreak Kills 20 In Michigan

The outbreak of hepatitis A in Michigan is more acute than any other state in the country. As of early December, 583 confirmed cases of the disease — which attacks the liver and has led to 20 deaths in Michigan since August 2016 — have been reported to health officials, a rate of 5.3 per 100,000 people or 38 percent higher than Utah, the state with the second highest rate, according to multiple media reports.

While cases have been reported in other counties, the majority of cases are from the city of Detroit, and Macomb, Monroe, Oakland, Wayne, and St. Clair counties, according to the Michigan Department of Health and Human Services. The total number of cases represents about a 10 fold increase, the Detroit Free Press reported.

"The Southeast Michigan hepatitis A outbreak remains a top priority for public health officials from both the investigation and prevention standpoints," Dr. Eden Wells, chief medical executive for MDHHS, said in a statement. "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.”

An exact cause of the outbreak hasn’t been determined. The majority of people infected with the disease appears to through illicit drug use, sexual activity, and close contact among household members, MDHHS officials said earlier this fall. About half of the cases have a history of substance abuse, while significant numbers of cases involve people in transient or homeless housing situations, and people with a recent history of incarceration, state health officials said.

"We're continuing to see new cases almost every day so it is a concern," said Macomb County Health Department Director Bill Ridella told the Detroit Free Press. "I think there is a strong connection to a number of these cases with the opioid and heroin problem. About half of the cases in Macomb County has some connection with drug use and/or heroin."

People 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.

The outbreak has more recently affected the food industry in southeast Michigan. The Detroit News reported that workers at Andy’s Pizza & Subs on Dec. 1, and Paul's Pizza in Detroit and Papa Romano's on Nine Mile at Telegraph Road in Southfield on Tuesday were diagnosed with hepatitis A.

In response, Oakland County Health Division is holding two Hepatitis A vaccination clinics for food service workers Tuesday and Wednesday. Hepatitis A can be transmitted by consuming food or beverages handled by infected persons.

Vaccination clinics will be open specifically for food workers on the following dates:

• Tuesday, Dec. 12, 9 a.m. – 5 p.m. at North Oakland Health Center, 1200 N. Telegraph Rd., Building 34E, in Pontiac
• Wednesday, Dec. 13, 9 a.m. – 5 p.m. at South Oakland Health Center, 27725 Greenfield Rd., in Southfield

The production of the hepatitis A vaccine is being outpaced by the demand because of the national outbreak, the Free Press reported. "The demand for adult hepatitis A vaccine(s) has increased substantially over the past six months and vaccine supply to meet this unexpected demand in the U.S. has become constrained," the CDC said in a statement to the Free Press.

But there are steps everyone can take to curb the spread of the disease, Oakland County health officials said. They include:

• Wash hands frequently, especially after using the bathroom, changing diapers, and before preparing and eating food. Rub hands vigorously with soap and warm running water for at least 20 seconds.
• Clean and disinfect all surface areas, especially while someone in the household or workplace has symptoms. Particular care needs to be taken with areas such as toilets, sinks, trash cans, door knobs, and faucet handles.
• Do not prepare food if you have symptoms and refrain from food preparation for at least three days after symptoms have ended, or two weeks after onset of clinical symptoms, whichever is longer.
• Exclude ill food service workers from the establishment immediately until clearance is given from Oakland County Health Division.

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 noc@oakgov.com
• Clair County Health Department, 810-987-5300
• Wayne County Communicable Disease Unit, 734-727-7078

Photo by Spencer Platt / Staff / Getty Images News / Getty Images