Louisville Medicine Volume 65, Issue 11 - Page 10

PUBLIC HEALTH PHYSICIANS CAN HELP CONTROL Louisvilleā€™s Current Hepatitis A Outbreak Lori Caloia, MD I received an interesting welcome to my new position as medical director for the Louis- ville Metro Department of Public Health and Wellness (LMPHW). The day after I started, the Kentucky Department of Public Health (KDPH) declared an outbreak of acute hepatitis A Virus (HAV) in our state. This outbreak has primarily affected Jefferson County. As of Feb- ruary 23, we had 99 cases concentrated mostly in the Downtown and Portland areas, but in other locations as well. As many of you may recall from medical school days, HAV is spread through the fecal-oral route, has a 15-50 day incubation period, and causes acute symptoms of nausea, vomiting, abdominal pain, dark urine, diarrhea, light stools, fever, fatigue, malaise, loss of appetite, joint pain and, most notably, jaundice. The diagnosis is confirmed with HAV IgM antibody testing. It can be deadly, partic- ularly in those with co-morbid conditions such as other forms of liver disease. But, there are things we can do to prevent the spread if we are able to quickly identify and interview cases, notify contacts of potential exposure, and provide post-exposure prophylaxis in the form of hepatitis A vaccine or Immunoglobulin (IG). Initially, my planning/organizing/optimistic brain went right to work thinking of how we could easily and quickly get this HAV out- 8 LOUISVILLE MEDICINE break under control. In my previous experience as a flight surgeon in the US Air Force, my role included public health functions on our base, such as responding to communicable disease events. Pertussis and Shigella outbreaks on our base were quickly identified, easily in- vestigated, and preventive measures and post-exposure prophylaxis with medication and vaccine were rapidly administered. All of this was very easy to do when I had a tightly controlled environment and an incredibly compliant population. The current HAV outbreak in Jefferson County, however, has been much more challenging! It has affected people in a broad area of our city, county and state. It has primarily impacted those who are homeless or with unstable housing, and people who use drugs (PWUD). Both of these groups are not only difficult to track down, but also hard to convince that we intend to provide help by preventing illness. Many are suspicious when we ask questions about their possible contacts in order to try to provide post-expo- sure prophylaxis in a timely manner. They often leave the hospital against medical advice (AMA) before we interview them to ask important questions that would help us stop the spread of disease. It is like trying to keep grains of sand from seeping through your fingers. You just do the best you can, and only end up with a few grains remaining despite your best efforts. In addition to the complexities of our medical population in