Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016-2018.

Minji Kang,Frank E Myers,Marlene Millen,Brian Clay,Sarah Stous,Amy Sitapati,Shira R Abeles,Sarah F Horman,Danelle R Wallace,Randy A Taplitz,Eric C Mcdonald,Francesca J Torriani

doi:10.3201/eid2607.191352

Abstract

During 2016–2018, San Diego County, California, USA, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades. In close partnership with local healthcare systems, San Diego County Public Health led a public health response to the outbreak that focused on a 3-pronged strategy to vaccinate, sanitize, and educate. Healthcare systems administered nearly half of the vaccinations delivered in San Diego County. At University of California San Diego Health, the use of informatics tools assisted with the identification of at-risk populations and with vaccine delivery across outpatient and inpatient settings. In addition, acute care facilities helped prevent further disease transmission by delaying the discharge of patients with hepatitis A who were experiencing homelessness. We assessed the public health roles that acute care hospitals can play during a large community outbreak and the critical nature of ongoing collaboration between hospitals and public health systems in controlling such outbreaks.

Highlights

Hepatitis A virus (HAV) is transmitted through the fecal–oral route either by person-to-person contact or by ingestion of contaminated food or water [1]
Hepatitis A Cases During November 1, 2016–October 31, 2018, a total of 592 confirmed or probable outbreak-associated cases of HAV infection occurred in San Diego County
Before the outbreak period (November 1, 2012–October 31, 2016), acute hepatitis A was diagnosed in 9 patients at University of California San Diego Health (UCSDH), of whom 5 (56%) were hospitalized

Summary

Introduction

Hepatitis A virus (HAV) is transmitted through the fecal–oral route either by person-to-person contact or by ingestion of contaminated food or water [1]. During 2016–2018, San Diego County, California, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades [5]. This outbreak was characterized by hepatitis A spread through person-to-person contact among persons experiencing unstable housing situations with or without illicit drug use [5]. Since 2017, similar outbreaks have been reported in 25 states; some of the index cases in those outbreaks were linked to San Diego. The public health response to the outbreak in San Diego focused on a 3-pronged strategy to vaccinate, sanitize, and educate [7]. We report the public health contribution of the academic medical center through the implementation of hospital-level prevention and outbreak management activities

Methods

Results

Conclusion