The Michigan Department of Health and Human Services has not yet identified a common source of the outbreak as of October 12, 2017. Between August 1, 2016, and October 12, 2017, there have been 397 confirmed cases of HAV in Michigan with 15 fatalities and 320 hospitalizations (85.6%).
1, 2 However, there has been a resurgence in the incidence of HAV in the U.S., with recent outbreaks occurring in San Diego, Los Angeles, New York City, Michigan, Hawaii, and several other counties and states. The incidence of HAV decreased from six cases per 100,000 in 1999 to 0.4 cases per 100,000 in 2011. in 1995, vaccination was not routinely recommended for children in California until 1999, and across the U.S. Although vaccine became available in the U.S. The incidence of hepatitis A virus (HAV) infection steadily decreased in the United States (U.S.) and other developed countries following the introduction of the HAV vaccine. ED personnel should inform local public health departments of any suspected case. Additionally, ED providers should offer post-exposure prophylaxis to exposed contacts and encourage vaccination as well as other preventive measures for at-risk individuals.
Hand hygiene with soap and warm water should be emphasized, and affected patients should be counseled to avoid food preparation and close contact with vulnerable populations. Healthcare providers should maintain strict standard precautions for all patients suspected of having HAV infection as well as contact precautions in special cases. While it can be asymptomatic, HAV typically presents with a prodrome of fever, nausea/vomiting, and abdominal pain followed by jaundice. Through use of the “Identify-Isolate-Inform” tool as adapted for HAV, emergency physicians can become more familiar with the identification and management of patients presenting to the emergency department (ED) with exposure, infection, or risk of contracting disease. Accordingly, HAV is proving to present a renewed public health challenge.
These outbreaks have had far-reaching consequences, with a large number of patients requiring hospitalization and several deaths. Although the overall incidence of HAV has been declining since the introduction of the HAV vaccine, there have been an increasing number of outbreaks within the United States and elsewhere between 20. Infection with hepatitis A virus (HAV) causes a highly contagious illness that can lead to serious morbidity and occasional mortality.
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