The Journal of the Arkansas Medical Society Med Journal April 2020 | Page 11

AFMC: A CLOSER LOOK AT QUALIT Y
TABLE 1. Characteristics, risk factors and co-morbidities
of Arkansas hepatitis A outbreak, Dec. 2017–Dec. 2019
CHARACTERISTIC
NUMBER (%)
Drug use 271 (60%)
Self-reported injection drug use 156 (58%)
Hospitalizations 236 (52%)
Co-infected with hepatitis C 112 (25%)
Incarcerated in the past two months 22 (5%)
Food handlers 21 (5%)
Co-infected with hepatitis B 19 (4%)
Homeless individuals 15 (3%)
Men who have sex with men (MSM)
free clinics to persons at risk for
acquiring the virus. Another 15,000
vaccinations have been given as a
result of food exposure.
Using a cost estimate from a
previous hepatitis A outbreak that
includes medical care, public health
personnel and lost productivity
costs, ADH estimates the cost of this
outbreak may exceed $5 million. 7
In an effort to end this outbreak,
ADH continues to investigate cases
in a timely manner; communicate
relevant information to the public,
stakeholders and policy-makers;
and collaborate with county
judges and county health officers
to identify and target high-risk
populations for vaccination.
Many states, including Arkan-
sas, have been responding to this
outbreak for more than a year. It
has proven difficult to address and
contain among high-risk individu-
als, largely due to the challenge of
effectively engaging and providing
preventative care to high-risk groups.
Drug users, MSM and homeless
Volume 116 • Number 10
8 (2%)
persons are often marginalized and
stigmatized. Additionally, the wors-
ening opioid and stimulant epidemic,
compounded with a scarcity of drug
abuse treatment resources, has likely
contributed to the perpetuation of
the hepatitis A outbreak nationally
and in Arkansas.
More cases of hepatitis A are
likely in the coming months, but
ADH and its partners will continue
to work toward innovative strategies
to combat the outbreak and stymie
the virus’ spread through targeted
vaccination and education. ADH
needs the help of all physicians to
control this outbreak. We ask you to
intervene in three ways:
• Consider a hepatitis A diagnosis
in any case with typical symptoms;
order hepatitis A IgM testing in
those patients.
• Identify and vaccinate those with
risk factors (illicit drug use, home-
lessness, MSM, etc.) for hepatitis A.
• Report all cases of hepatitis A
(and other reportable diseases) to
ADH at 501-537-8969.
Complete hepatitis A vaccination
recommendations at https://www.
cdc.gov/hepatitis/outbreaks/
InterimOutbreakGuidance-HAV-
VaccineAdmin.htm.
The Health Alert Network (HAN)
provides notification regarding out-
breaks or other public health events.
Learn more about HAN and sign up
for alerts at https://hanregistration.
adh.arkansas.gov. s
Dr. Dillaha is ADH medical director for
immunizations and outbreak response.
Dr. Cima is ADH chief epidemiologist
and associate director for science. Dr.
Tumlison is ADH medical director for
child and adolescent health. Mr. May is
ADH health program specialist I.
REFERENCES
1. Purcell, RH, Wong, DC, Shapiro, M. Relative
infectivity of hepatitis A virus by the oral and
intravenous routes in 2 species of nonhuman
primates. J Infect Dis, 2002. 185(11):1668-71
2. Fiore, AE, Hepatitis A transmitted by food. Clin
Infect Dis, 2004. 38(5): 705-15
3. Ott, JJ, Wiersma, ST. Single-dose administra-
tion of inactivated hepatitis A vaccination in
the context of hepatitis A vaccine recommen-
dations. Int J Infect Dis, 2013. 17(11):e939-44
4. Viral hepatitis surveillance: U.S. 2017, Centers
for Disease Control and Prevention. 2019; at:
https://www.cdc.gov/hepatitis/statistics/
2017surveillance/pdfs/2017HepSurveil-
lanceRpt.pdf
5. Widespread person-to-person outbreaks of
hepatitis A across the U.S., CDC 2020; at:
https://www.cdc.gov/hepatitis/outbreaks/
2017March-HepatitisA.htm
6. Hofmeister, MG, et.al., Estimating prevalence
of hepatitis C virus infection in the U.S., 2013-
2016. Hepatology, 2019. 69(3):p.144-51
7. Epson, EE, et.al., Risk factors for hospitalisation
and associated costs among patients with
hepatitis A associated with imported pome-
granate arils, U.S., 2013. Public Health, 2016.
136:144-51
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
APRIL 2020
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