Hepatitis A Virus

Although cases of acute HAV have declined in recent years, elevated numbers of HAV infections began to be reported by California and Michigan in the fall of 2016.1,2 Since this time, associated outbreaks have been reported in 9 additional states (Arizona, Utah, Kentucky, Missouri, Tennessee, Indiana, Ohio, Arkansas, and West Virginia).3 No common source of food, beverages or drugs have been identified and transmission appears to be primarily person-to-person with high-risk individuals including people experiencing homelessness, those who use illicit drugs and their close direct contacts. In June 2018, CDC issued a Health Alert Network Advisory providing additional guidance on identification and prevention of HAV and updates on the outbreaks.4 This prompted our office to more closely review our HAV surveillance, to identify Veterans who may be part of these outbreaks, and assess risk factors and outcomes of HAV infection.

Objective: To conduct surveillance for acute Hepatitis A virus (HAV) infections in Veterans from states reporting outbreaks among high-risk individuals beginning in fiscal year (FY) 2017.

Since hepatitis A vaccination became widely recommended in the US in the mid-1990's, rates of acute hepatitis A virus (HAV) infection have steadily declined, however, since 2011, incidence of new cases of HAV appears to be increasing1, often linked with foodborne outbreaks and socio-economic trends such as homelessness and substance abuse.2 In 2016, the CDC reported vaccination coverage among adults aged > 19 was 9.5%, 19-49 was 13.4%, and > 50 was 5.4%3. CDC issued a Health Alert Network Advisory in June 2018 with additional guidance on identification and prevention of HAV and updates on outbreaks in multiple states4 which prompted our program to conduct a more formal review of HAV infections in VHA. Herein we describe recent trends in HAV infection, vaccination and associated risk factors among Veterans.

Objective: To describe the epidemiology of hepatitis A virus (HAV) within the Veterans Health Administration (VHA).

Hepatitis A virus (HAV) infection is usually mild in childhood but more severe in adolescents and adults'. An estimated 1.4 million cases of HAV infection occur annually in the world. The case-fatality rate among patients of all ages is approximately 0.3%, but tends to be higher among older persons (approximately 2% over 40 years of age). HAV is a notifiable disease on weekly basis where health centers and hospitals report cases to the health directorates which in turn report electronically to the Communicable Diseases Directorate, with subsequent paper reporting of detailed epidemiological description. The due time is Tuesday next week. Diagnosis is clinically based and depends on case definition..A previous study in Jordan revealed that reporting rate increased from 6.4 in 2004 to 7.9 in 2008/100,000, the highest reporting rate was in the North region mainly Mafraq.

Objective

The study aims to asses' HAV surveillance in Mafraq Health directorate, and to determine whether the increase in reporting is related to a public health issue or is a result of a relatively good surveillance.

In early 2017, HAV outbreaks were identified in San Diego County (490 cases) and Santa Cruz County (73 cases) in California, affecting primarily the homeless and/or illicit drug users. As of October 10, 2017, LAC had identified 12 outbreak-related HAV cases. Due to LAC’s proximity to San Diego County, and its own large homeless population, the syndromic surveillance team of the LAC Department of Public Health created a syndrome category and began querying its ED data to monitor for any increase in HAV-related visits.

Objective:

To create a hepatitis A virus (HAV) syndrome category with which to monitor emergency department (ED) visits for situational awareness during a currently emerging Hepatitis A community outbreak in Los Angeles County (LAC), and to evaluate its usefulness.

On 3/29/2017, the Maricopa County Department of Public Health (MCDPH) received three reports of confirmed HAV infection from an onsite clinic at Campus A that assists individuals experiencing homelessness, a population at risk for HAV transmission. To identify the scope of the problem, the department initiated rapid HAV infection case detection using NSSP ESSENCE.

Objective:

To demonstrate the utility of the National Syndromic Surveillance Program’s (NSSP) version of the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) for case detection during a 2017 outbreak of hepatitis A virus (HAV) infection among persons experiencing homelessness in Maricopa County, Arizona.