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Detroit targets hepatitis A outreach: "What we're trying to do is reach people where they are"

Dr. Joneigh Khaldun is Detroit's health department director.

Detroit is trying to fight a hepatitis A outbreak in the face of limited resources and low national vaccine supplies.

Detroit health department director Dr. Joneigh Khaldun talked about the city’s efforts to fight an outbreak of the viral liver disease on a conference call with other local and national health leaders Tuesday.

Michigan is one of a handful of states experiencing hepatitis A outbreaks right now. Michigan’s is one of the largest, with 610 cases and 20 deaths reported since August 2016.

Some of the highest-risk populations, including drug users and people experiencing homelessness, are also some of the hardest to reach. Khaldun says that’s especially true in Detroit, where the homeless population often means people living in transient housing spread out across the city.

So to fight the outbreak, “What we’re doing is trying to reach people where they are,” Khaldun said. That includes working with shelters, health clinics and other partners to screen and vaccinate people. In recent weeks, the health department has also brought on emergency rooms at the city’s four major hospitals to do that work.

The city is also following up with people in close contact with known hepatitis A cases. They can be protected if they receive a vaccine or immunoglobulin within two weeks of exposure.

“For every case that comes through and is associated with a city of Detroit resident, my team immediately responds to identify who those contacts can be, so that we can quickly get that person that post-exposure prophylaxis,” Khaldun sasid.

But that kind of follow-up is a challenge for a department with just three epidemiologists and limited resources. Another challenge: limited national vaccine supplies.

Khaldun says the city is relying on other health agencies to help supplement its efforts. The department is also purchasing more doses from private vendors, but can only get so much at a time. “So we’ve literally been every day purchasing 400 [doses], our max,” she said.

In addition to targeting high-risk populations for vaccination, the city has also vaccinated all its medical first responders, police officers, water and sewerage department workers, and others who routinely cross paths with the high-risk, or have the potential to contaminate water supplies or otherwise spread the disease.

As of this week, that now includes food service workers, who are the target of new mobile vaccination clinics. The first mobile clinic was out Tuesday at the University of Detroit-Mercy.

Mass sanitation efforts, like those conducted by Southern California health officials dealing with their own heptatis A outbreaks, make less sense in southeast Michigan because the high-risk population is more dispersed, Khaldun said. The city does ask about water shutoffsas part of its routine investigation into each hepatitis A case, but Khaldun says no cases have been linked to shutoffs so far.

Eight hepatitis-related deaths have occurred in Detroit during the outbreak period. But Khaldun says we should be careful about attributing any death solely to the virus, since most who die from it have other significant health problems.

“Those deaths do not mean the person died from hepatitis A,” Khaldun said. “While there have been 20 deaths in southeast Michigan associated with hepatitis A, that does not mean that’s officially the cause of death.”

Sarah Cwiek joined Michigan Public in October 2009. As our Detroit reporter, she is helping us expand our coverage of the economy, politics, and culture in and around the city of Detroit.
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