MDHHS activates CHECC in response to hepatitis A outbreak

LANSING, Mich. – As cases continue to rise, the Michigan Department of Health and Human Services (MDHHS) has activated the Community Health Emergency Coordination Center (CHECC) to coordinate the response of the multiple jurisdictions involved in the hepatitis A outbreak.

“To help coordinate Michigan’s response to the hepatitis A outbreak, we are opening the Community Health Emergency Coordination Center to assist the multiple local public health jurisdictions involved in the response and prevention of further cases,” said MDHHS Director Nick Lyon.

The CHECC has been activated to provide support to impacted jurisdictions including local health departments, hospitals, EMS, healthcare coalitions and other healthcare providers. This coordination and communication support includes responding to requests for health related resources, developing and distributing guidelines and educational materials to meet the needs of this outbreak.

As there are indications that the outbreak could spread outside of the Southeast region of Michigan, MDHHS is urging all healthcare providers to promote hepatitis A vaccination to the highest risk individuals, including:

  • Persons with a history of substance use
  • Persons currently homeless or in transient living
  • Men who have sex with men (MSM)
  • Persons incarcerated in correctional facilities
  • Food handlers
  • Healthcare workers
  • Persons with underlying liver disease
  • Persons who are in close contact with any of the above risk groups
  • Persons wishing to be immune to hepatitis A

“We know that the hepatitis A vaccine is more than 90 percent effective in protecting someone who may be exposed to hepatitis A,” said Dr. Eden Wells, Chief Medical Executive with the MDHHS. “Without a
single source associated with these cases, the importance of vaccination and proper hygiene is vital to ensuring we stop the person-to-person spread of hepatitis A.”

Since August 1, 2016, there have been 457 confirmed cases of hepatitis A, including 18 fatalities, associated with this outbreak in the City of Detroit, Huron, Ingham, Lapeer, Livingston, Macomb, Monroe, Oakland, Sanilac, St. Clair, Washtenaw, and Wayne Counties reported to MDHHS.

Primary cases range in age from 20 to 87 years with median age of 42 years. Sixty-three percent are male and 85.6 percent have been hospitalized. Forty-eight percent of cases reported illicit drug use, 27 percent of cases were co-infected with hepatitis C, and three percent co-infected with hepatitis B. Six percent report recent incarceration, and 7.7 percent are MSM. Transmission is primarily person-to-person, as no single source has been identified.

Due to the temporary limitations on the availability of Adult Hepatitis A vaccine, MDHHS recommends that healthcare providers postpone administration of the second dose of Adult hepatitis A vaccine unless individuals require the second dose to address high risk conditions, including travel to a hepatitis A endemic country. Pediatric hepatitis A vaccine should continue to be administered routinely as there are
no limitations on the availability of this vaccine for those 18 years and younger.

MDHHS today broadly issued a statewide message through the Health Alert Network to encourage healthcare providers across Michigan to be on alert for hepatitis A infection in high risk individuals and to order testing when suspected as soon as possible. The earlier the report of a case is received, the better chance public health officials have at determining exposure and administering appropriate interventions.

MDHHS and local public health officials are working to quickly investigate cases as they are identified, as well as notify the healthcare community and encourage providers to speak with their patients about hepatitis A, increase vaccinations, and test for hepatitis A when appropriate. These activities include:

  • On September 18, the state Medicaid program issued a letter to healthcare providers about the outbreak, testing information, including prevention, testing, and treatment information. This letter was sent to 5,069 Medicaid-enrolled providers and another 11,758 providers and interested parties signed up for Medicaid updates.
  • There are ongoing vaccination campaigns in jails, substance use treatment centers, health departments, emergency departments, and homeless centers, as well as with the Michigan Department of Corrections to reach highest risk individuals.
  • Supported by contracted nurses from the Visiting Nurse Association, MI Volunteer Registry volunteers, and MDHHS, local health departments are partnering with community organizations to provide hepatitis A vaccine to at-risk individuals.

More information about the hepatitis A outbreak in Michigan and current recommendations are available at www.michigan.gov. Michigan residents are also encouraged to contact their local health department for more information or vaccination.