Preliminary Case Series Provides Snapshot of Hepatitis A Outbreak in Michigan

Health officials across the United States continue to struggle with several hepatitis A outbreaks that have sprung up around the country.

One of the outbreaks that has reared its ugly head in Michigan is what has been referred to as the nation’s deadliest outbreak out of the ones happening right now. The state has been reporting an unusual increasing trend of hepatitis A infections since August 2016. As of April 18, 2018, the Michigan Department of Health and Human Services reports that a total of 815 individuals have fallen ill in the outbreak with 80.6% of these individuals requiring hospitalization for their infections. Furthermore, 25 individuals have died.

In a poster presentation at the SHEA Spring 2018 Conference, Amar Krishna, MD, from the division of Infectious Diseases at the Detroit Medical Center/Wayne State University shared a preliminary case series of confirmed hepatitis A infection cases who were treated at 1 of the largest health care facilities in Southeast Michigan: Detroit Medical Center.

The investigators looked at a cohort of hepatitis A-confirmed patients who had been admitted to the tertiary care facility in Detroit, Michigan between August 2016 and December 2017, according to the poster. They collected information pertaining to each patient’s demographics, risk factors, comorbidities, clinical presentations, outcomes, and laboratory results for analysis.

Dr. Krishna reported that a total of 94 hepatitis A infections were diagnosed during their study period and the median age of the patients included in their analysis ranged from 15 to 87 years.

The investigators noted a higher incidence of infection among men than women (67%) and among African Americans compared with other races (59.5%). Among the most common clinical presentations were abdominal tenderness (69.1%), followed by jaundice (65.9%), nausea (63.8%), and vomiting (54.2%), as well as fatigue (53.1%) and fever (28.7%).

The common risk factors noted in their analysis included: IV (26.5%) and non-IV (43.6%) drug use, alcohol use (57.4%), men who have sex with men (4.2%), homeless/transient living (14.8%), and being a correctional facility inmate (8.5%).

This is not the first time that homelessness has been associated with hepatitis A. The large outbreak that is currently happening in San Diego, California, is mostly occurring among the homeless population.

Comorbidities reported among the patients include co-infection with hepatitis C virus (19 patients—however, none were positive for HBsAg (the surface antigen of the hepatitis B virus); a history of chronic liver diseases (10 patients), and development of fulminant hepatitis (13 patients). Nine out of those 13 patients were evaluated for liver transplantation.

One death was reported, and 2 patients were transferred to hospice care.

A common source of infection was not identified.

“The ongoing Hepatitis A outbreak in Michigan is considered one of the largest outbreaks in the United States within the last 2 decades. The majority of our cohort belongs to a well-recognized hepatitis A risk group (IV and non-IV illicit drug abuser, homeless /transient living, MSM, incarcerated),” the authors concluded. “Despite the continual breakthroughs in hepatitis A diagnosis and management, accessibility of vaccination to the vulnerable population continues to be the biggest challenge and the pivotal cause for such ongoing epidemics.”