Perspectives

Public Health Response to Hepatitis A Outbreak

By Guest Author, Annette Mercatante MD, MPH

There is a hepatitis A outbreak occurring in Southeast Michigan that is spreading throughout the state. Since August 2016 our region of the state has experienced a 16-fold increase in hepatitis A cases. It’s important to put this infectious disease and its prevention in the proper perspective. The infection attacks the liver and can last several weeks, resulting in hospitalizations and even death. Some people can be infected and not have symptoms, especially infants and children, but still shed the virus. Hepatitis A was identified in 1979 and a vaccine became available in 1996 resulting in historically low levels of the disease, but it is clearly not gone! Despite being a very effective and safe vaccine, few people have taken advantage of it. Only 43% of our county toddlers’ ages 19 – 35 months are fully vaccinated against hepatitis A, and less than 10% of our adults. Unfortunately, many county residents continue to resist and distrust vaccines.

Recently there was a hepatitis A case in a food worker in Algonac. Infection in a food handler is of particular concern because the germ is spread through “fecal-oral” transmission and many people could potentially eat contaminated food if proper hygiene and food handling are not followed. The food worker became a victim of this outbreak, and there was nothing the restaurant owner, worker or patrons of the restaurant could have done EXCEPT get vaccinated and follow proper procedures. In this situation no one was to blame. The St. Clair County Health Department (SCCHD) worked hard to protect the health of those who may have been exposed. By following expert guidance, we provided two community vaccination clinics to protect people who had a potential of getting sick. In less than 6 hours we provided over $60,000 dollars’ worth of vaccine at no charge. Of course, none of this was free and does not include the time of having highly skilled staff there to provide this service over a two-day period. The SCCHD is committed to providing the highest quality of services we can. If we prevented even one disease transmission, it was well worth the effort. We anticipate that vaccinating approximate downriver residents has helped prevent further spread of this outbreak.

We hope the services provided were of value to those affected and that future responses to a disease exposure will have the same level of support. However, I urge everyone to take a deep breath and remember that no-one can do everything for everyone. Part of your responsibility is to be prepared for emergencies, including getting sick. Important preventive measure like being fully vaccinated, proper hand washing and good hygiene are great ways to reduce your risk, but it will never be completely eliminated. With this ongoing outbreak and potential shortage of this vaccine, we will continue to find ways to do the most good with what we have. We are committed to using scientific information, responsible communication, and most importantly, weighing all risk and benefits before advising an action.

Yours in Health,
Annette Mercatante, MD, MPH
Medical Health Officer
St. Clair County Health Department
www.scchealth.co
Follow us on Social Media @scchdmi

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Dr. Mercatante grew up on the east side of Detroit and learned at an early age what poverty and community can mean for health.  After high school she received a BS degree in Medical Technology from Michigan State University, her MD from Wayne State School of Medicine/Detroit, and completed a Family Medicine Residency from St John Hospital/Detroit.  She has remained Board Certified in Family Practice and has spent over 20 years in primary care in St Clair County.  She received her Masters of Public Health (MPH) from University of Massachusetts/Amherst in 2011.   First as Medical Director, and now as the Medical Health Officer for the St Clair County Health Department, she sees Local Public Health as a critical component of healthcare reform and improving population health.

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About the author

Annette Mercatante, MD, MPH

Dr. Mercatante grew up on the east side of Detroit and learned at an early age what poverty and community can mean for health.  After high school she received a BS degree in Medical Technology from Michigan State University, her MD from Wayne State School of Medicine/Detroit, and completed a Family Medicine Residency from St John Hospital/Detroit.  She has remained Board Certified in Family Practice and has spent over 20 years in primary care in St Clair County.  She received her Masters of Public Health (MPH) from University of Massachusetts/Amherst in 2011.   First as Medical Director, and now as the Medical Health Officer for the St Clair County Health Department, she sees Local Public Health as a critical component of healthcare reform and improving population health.  

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