Louisville Medicine Volume 65, Issue 11 - Page 11

the outbreak , resource limitations such as budgetary constraints on availability of vaccine and staff have also created challenges . Though this is an “ outbreak ,” it has not yet been declared a public health emergency , so additional federal funding and resources are not readily available . The outbreak has also gone largely under the media radar , in part due to other medical concerns this time of year , including this taxing flu season .
Because of these challenges , we have had to be creative in our response . The idea of a “ mass vaccine ” campaign is likely to panic the general public unnecessarily , and send the “ worried well ” to get vaccinated , using up our limited supply of vaccine . Instead , we have approached this in a “ seek and find ” manner . We have sought out the most likely locations that we would find the population at risk , the homeless and PWUD , and brought vaccine to them . LMPHW has been vaccinating at homeless shelters and feeding sites , the LMPHW Syringe Exchange Program ( SEP ) and the Volunteers of America mobile SEP .
We even have a team of dedicated people ( a great thank you to Paul and volunteer Nancy Kern ) who have been vaccinating those in homeless encampments . We have been providing vaccinations to those in Louisville Metro correctional facilities and drug recovery locations in order to reach those at highest risk . We have also partnered with other local agencies , such as the University of Louisville and Kroger Little Clinic , to help provide vaccine to insured populations who may also be at risk due to their work with those at highest risk in the outbreak , for example homeless service providers , emergency medical service providers , correctional facility workers , police , firefighters , and medical personnel .
In these combined efforts to date , we have provided more than 4,000 hepatitis A and Twinrix vaccines . This is a great feat , considering in most of these locations , we may only provide a few vaccines in a given day . It has brought long hours of additional duties to the LMPHW staff , a staff who is incredibly dedicated , and I am thankful for that !
We were recently visited by the Center for Disease Control Epi- AID team to help evaluate our response so far and offer additional suggestions in our ongoing efforts . They were in awe of our efforts and results so far . However , the outbreak is far from over , and they have estimated that we will be dealing with this for at least six more months , unfortunately taking us into the Kentucky Derby season . Despite the best of efforts , these things just don ’ t go away quickly , and can even last for several years .
We at LMPHW are asking for your help as physicians as we continue to fight the spread of this outbreak . Here are some tangible things you can do to help improve our community response to this outbreak :
1 . Expand your differential diagnosis . Think of hepatitis A in your patient workup , particularly if they have jaundice or the outbreak risk factors for hepatitis A of homelessness or drug use .
2 . Order a hepatitis A IgM antibody test for confirmatory testing ( a hepatitis A total antibody does not help distinguish acute from prior infection or vaccination and should only be ordered to confirm immunity to HAV ). [ 2 ]
3 . Take a good history . Find out if infected patients have been in contact with anyone with hepatitis A , exactly when symptoms began ( particularly jaundice , as this helps us to determine their infectious period in which they could have spread the virus to others ), and where they have been living ( i . e . homeless , correctional facilities or other congregate settings ). Do they use drugs ? Do they have other co-morbid diseases such as hepatitis B or C that may put them at risk for severe outcomes ?
4 . Promptly report any suspected or laboratory confirmed case of hepatitis A to LMPHW . Call communicable diseases staff at ( 502 ) 574-6675 or fax EPID-200 form to ( 502 ) 574- 5865 . All communicable diseases are reportable to the health department ( acute hepatitis A within 24 hours ) [ 6,7 ] and the sooner we receive this information , the more time we have to contact the case patient , identify his / her contacts , and provide post-exposure prophylaxis , further preventing disease . Please don ’ t rely on someone else to do this . The hospital lab reporting is often delayed . You , who are caring for the patient , are the first to suspect and often the first to respond to the positive lab result . The infection prevention nurse at your hospital can help with the reporting . Please consider using our epidemiology data collection tool for obtaining historical information that can assist us at LMPHW with the outbreak investigation .
5 . Recommend hepatitis A vaccination to your patients ! As a routine preventive health measure , HAV vaccine is covered by insurance . It is an incredibly effective vaccine , with 96 – 100 percent seroconversion within four weeks of vaccination . Even one dose of vaccine can be effective for up to 10 years and completion of the two-part vaccine series confers 20 or more years of immunity . [ 1 ]
If your clinical environment ( clinic , urgent care or emergency room ) does not already have HAV vaccine on hand , consider purchasing it for those wishing to be vaccinated or those at risk .
If you do not have vaccine in your clinical environment , refer patients to local pharmacies for vaccination .
The Advisory Committee on Immunization Practices ( ACIP ) recommends that the following persons be vaccinated against hepatitis A :
• All children at age one year ,
PUBLIC HEALTH
• Persons who are at increased risk for infection ,
• Persons who are at increased risk for complications from hepatitis A , and
• Any person wishing to obtain immunity ( protection ). [ 2 ] ( continued on page 10 )
APRIL 2018 9
PUBLIC HEALTH the outbreak, resource limitations such as budgetary constraints on availability of vaccine and staff have also created challenges. Though this is an “outbreak,” it has not yet been declared a public health emergency, so additional federal funding and resources are not readily available. The outbreak has also gone largely under the media radar, in part due to other medical concerns this time of year, including this taxing flu season. Because of these challenges, we have had to be creative in our response. The idea of a “mass vaccine” campaign is likely to panic the general public unnecessarily, and send the “worried well” to get vaccinated, using up our limited supply of vaccine. Instead, we have approached this in a “seek and find” manner. We have sought out the most likely locations that we would find the population at risk, the homeless and PWUD, and brought vaccine to them. LMPHW has been vaccinating at homeless shelters and feeding sites, the LMPHW Syringe Exchange Program (SEP) and the Volunteers of America mobile SEP. We even have a team of dedicated people (a great thank you to Paul and volunteer Nancy Kern) who have been vaccinating those in homeless encampments. We have been providing vaccinations to those in Louisville Metro correctional facilities and drug recov- ery locations in order to reach those at highest risk. We have also partnered with other local agencies, such as the University of Lou- isville and Kroger Little Clin 2FV&fFRf66RF7W&V@VF2v6&RB&6GVRFFV"v&vFF6R@vW7B&6FRWF'&Vf"WRVW726W'f6R&fFW'2VW&vV7VF66W'f6R&fFW'26'&V7Ff6ƗGv&W'2Ɩ6Rf&VfvFW'2BVF6W'6VखFW6R6&VBVff'G2FFFRvRfR&fFVB&RFBWFF2BGv&f66W2F22w&VBfVB66BЦW&r7BbFW6R6F2vRǒ&fFRfWrf66W0vfVFB2'&VvBrW'2bFFFGWFW2FFRr7Ffb7Ffbv27&VF&ǒFVF6FVBBЧFgVf"FBvRvW&R&V6VFǒf6FVB'FR6VFW"f"F6V6R6G&WФBFVFVWfVFRW"&W76R6f"BffW"FFF7VvvW7F2W"vrVff'G2FWvW&RvRbW"Vff'G0B&W7VG26f"vWfW"FRWF'&V2f"g&fW"BFWfRW7FFVBFBvRv&RFVƖrvFF2f"BV7B6&PF2Vf'GVFVǒFrW2FFRVGV6FW&'6V6FW7FRFR&W7BbVff'G2FW6RFw2W7BF( BvvV6ǒB6WfV7Bf"6WfW&V'2vRBr&R6rf"W"V26622vP6FVRFfvBFR7&VBbF2WF'&VW&R&R6RFЦv&RFw2R6FFV&fRW"6VG&W76PFF2WF'&VWBW"FffW&VFFv62FbWFF2৖W"FVBv&W'F7V&ǒbFWfRVF6R"FPWF'&V&6f7F'2f"WFF2bVW76W72"G'VrW6R"&FW"WFF2tF&GFW7Bf"6f&F'FW7FrWFF2FFF&GFW2BVF7FwV67WFRg&&"fV7F"f66FB6VBǒ&P&FW&VBF6f&VGFb%У2FRvB7F'fBWBbfV7FVBFVG2fR&VV6F7BvFRvFWFF2W7FǒvV7F0&Vv'F7V&ǒVF6R2F2V2W2FFWFW&֖RFV fV7FW2W&Bv6FW6VBfR7&VBFRf'W2FFW'2BvW&RFWfR&VVƗfrRVW726"Ч&V7Ff6ƗFW2"FW"6w&VvFR6WGFw2FFWW6PG'Vw3FFWfRFW"6&&BF6V6W27V62WFF0""2FBWBFVB&6f"6WfW&RWF6W3B&Fǒ&W'B7W7V7FVB"&&F'6f&V@66RbWFF2Fr66V6&RF6V6W07FfbBS"SsBccsR"fUB#f&FS"SsBУScR6V6&RF6V6W2&R&W'F&RFFRVFFW'FVB7WFRWFF2vF#BW'2buBFP6W"vR&V6VfRF2f&FFR&RFRvRfRF6F7BFR66RFVBFVFg2W"6F7G2B&fFP7BW7W&R&2gW'FW"&WfVFrF6V6RV6PF( B&Vǒ6VRV6RFFF2FR7F"&W'Fp2gFVFVVBRv&R6&rf"FRFVB&RFPf'7BF7W7V7BBgFVFRf'7BF&W7BFFR6FfP"&W7VBFRfV7F&WfVFW'6RBW"7F6আVvFFR&W'FrV6R66FW"W6rW"WFV֖ЦwFF6V7FFf"'Fr7F&6f&FFB6767BW2BrvFFRWF'&VfW7FvFR&V6VBWFF2f66FFW"FVG22&WFR&WfVFfRVFV7W&Rbf66R26fW&VB'7W&6RB27&VF&ǒVffV7FfRf66RvFb( 2W&6VB6W&6fW'6vFfW"vVV2bf66FWfVRF6Rbf66R6&RVffV7FfRf"WFV'2@6WFbFRGv'Bf66R6W&W26fW'2#"&PV'2bVGФbW"6Ɩ6Vf&VB6Ɩ2W&vVB6&R"VW&vV7&ҒFW2B&VGfRbf66RB66FW"W"Ц66rBf"F6Rv6rF&Rf66FVB"F6RB&6खbRFBfRf66RW"6Ɩ6Vf&VB&VfW FVG2F6&6W2f"f66FFRGf6'6֗GFVRV旦F&7F6W24&V6VG2FBFRfvrW'62&Rf66FVBv7BWЦFF2( 6G&VBvRRV"( W'62v&RB7&V6VB&6f"fV7F( W'62v&RB7&V6VB&6f"6Ɩ6F2g&ЦWFF2@( W'6v6rF'FVG&FV7F%Т6FVVBvR$#