Abstract
IntroductionThe Philadelphia Department of Public Health (PDPH) declared a public health emergency due to hepatitis A in August 2019.1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission. This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission.MethodsWe conducted a retrospective review of all ED visits in the 12-week period centered around the implementation of the ED-based hepatitis A vaccination program. All adult patients presenting to the ED were offered vaccination, with vaccines supplied free of charge by the PDPH. We compared the incidence of diagnosis and of hospital admission for treatment of hepatitis A before and after implementation of the program.ResultsThere were 10,033 total ED visits during the study period, with 5009 of them prior to the implementation of the vaccination program and 5024 after implementation. During the study period, 669 vaccines were administered. Before the vaccination program began, 73 patients were diagnosed with hepatitis A, of whom 67 were admitted. After implementation of the program, 38 patients were diagnosed with hepatitis A, of whom 31 were admitted.ConclusionA partnership between an ED and the local public health department resulted in the vaccination of 669 patients in six weeks in the midst of an outbreak of a vaccine-preventable illness, with a corresponding drop in ED visits and hospital admission for acute hepatitis A.
Highlights
The Philadelphia Department of Public Health (PDPH) declared a public health emergency due to hepatitis A in August 2019.1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission
This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission
A partnership between an ED and the local public health department resulted in the vaccination of 669 patients in six weeks in the midst of an outbreak of a vaccine-preventable illness, with a corresponding drop in ED visits and hospital admission for acute hepatitis A. [West J Emerg Med. 2020;21(4):905-907.]
Summary
The Philadelphia Department of Public Health (PDPH) declared a public health emergency due to hepatitis A in August 2019.1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission. Populations at risk of acquiring hepatitis A include people experiencing homelessness, people who use drugs, men who have sex with men, and individuals recently incarcerated.[1] The homelessness crisis in many major United States cities has previously been identified as a contributing factor in the increasing numbers of outbreaks of infectious diseases such as hepatitis A.2. Prior data from a similar outbreak in San Diego in 2018 demonstrated that 64.7% of patients infected with hepatitis A were homeless and 39.8% reported drug use.[3]. The emergency department (ED) where the intervention took place is located within the section of Philadelphia where many hepatitis A cases were being reported, and serves the identified high-risk populations. The population includes a high volume of patients with substance use disorder, with the highest frequency of naloxone administration compared to other larger EDs in the city.[4]
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