51
|
Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26:222-226. [PMID: 32235205 DOI: 10.1097/phh.0000000000001152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT In the midst of the current opioid epidemic, states have selected differing legislative routes implementing pathways to ensure access to clean needles and syringes. OBJECTIVE To determine whether states that implemented laws supporting syringe exchange programs (SEPs) had reductions in transmission rates of hepatitis B, hepatitis C, and HIV infection compared with states without such laws. DESIGN AND SETTING Utilizing a longitudinal panel design, we determined the legal status of SEPs in each state for years 1983-2016. Disease transmission rates for this period were estimated via a simple Poisson regression, with transmitted cases as the dependent variable, law categories as the predictor variables, and the log of state population as the exposure. The mean number of incident cases per state-year was also calculated. PARTICIPANTS US states were utilized as the unit of analysis. RESULTS Hepatitis B and hepatitis C mean transmission rate per 100 000 population declined in states with local ordinances/decriminalized statutes and legalized SEPs (hepatitis B: 71% and 81%, respectively, differences P < .001; hepatitis C: 8% and 38%, respectively, differences P < .001). Reductions in mean incident cases per state-year mirrored these findings. HIV infection among injection drug users yielded inconsistent results. CONCLUSIONS Hepatitis B and hepatitis C transmission were reduced at the population level in states with SEP laws in a pattern reflecting the degree of legal intervention. HIV infection, based upon a smaller data set, showed a mixed impact. POLICY IMPLICATIONS The results show promise that SEPs have population-level effects on disease transmission. States lacking SEPs should reconsider current policies.
Collapse
|
52
|
Fisher DG, Reynolds GL, Khoiny N, Huckabay L, Rannalli D. Application of the Frailty Framework among Vulnerable Populations to Hospitalization Outcomes of Individuals Experiencing Homelessness in Long Beach, California. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2021; 31:163-171. [PMID: 36439946 PMCID: PMC9697922 DOI: 10.1080/10530789.2021.1908487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/07/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Individuals experiencing homelessness have a high prevalence of infectious diseases that may result in hospitalization. However, low ability to navigate the healthcare system and lack of health insurance may mean that those who are experiencing homelessness may not receive the healthcare that they need. OBJECTIVES This study uses risk factors at baseline to predict hospitalization at follow-up. This paper also presents the associations between reporting homelessness and selected infectious diseases. RESEARCH DESIGN Longitudinal study of baseline and follow-up conducted August 2000 through July 2014. SUBJECTS 4916 Not experiencing homelessness mean age 37.9 years, 29% female, and 2692 experiencing homelessness age 42.1 years, 29% female received services from a research/service center in a low-income, high-crime area of Long Beach, CA. MEASURES Risk Behavior Assessment, Risk Behavior Follow-up Assessment, laboratory testing for hepatitis A, hepatitis B, hepatitis C, syphilis, chlamydia, and gonorrhea. RESULTS Predictors of hospitalization at follow-up were ever use of crack cocaine, income from Social Security or disability, reporting homelessness, female, and those who identify as Black compared to White race/ethnicity. CONCLUSIONS Income from the safety net of Social Security or disability appears to provide the participant with experience that transfers to being able to obtain healthcare. A higher proportion of those experiencing homelessness, compared to those not experiencing homelessness, appear to be hospitalized at follow-up. Women, those who identified as Black, and those who used crack at baseline are more likely to be hospitalized at follow-up whether or not they were experiencing homelessness. We recommend coordination with substance abuse treatment programs for discharge planning for homeless patients. Our findings support use of the Frailty Framework when working with individuals experiencing both homelessness and hospitalization.
Collapse
Affiliation(s)
- Dennis G Fisher
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Grace L Reynolds
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Noushin Khoiny
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Loucine Huckabay
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Debby Rannalli
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| |
Collapse
|
53
|
Krsak M, Montague BT, Trowbridge P, Johnson SC, Binswanger IA. Opioid Use and Chronic Infections: The Value of Addressing the Syndemic in Correctional Settings Via Telemedicine Guidance and Broader Use of Long-Acting Medications. J Infect Dis 2021; 222:S486-S493. [PMID: 32877543 DOI: 10.1093/infdis/jiaa001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the United States, we are experiencing linked epidemics (a syndemic) of substance use disorders (SUDs) and infections associated with drug use, including unsafe injecting and unsafe sex in exchange for drugs or money. Current drug laws, together with risk-taking behavior among persons with SUDs, contribute to disproportionately high prevalences of these conditions in correctional settings. Detection and treatment of diseases with a high impact on public health are best addressed in the settings where such conditions are most prevalent (ie, jails and prisons for SUDs and chronic infections). The effectiveness, safety, cost of care. and public health impact of these conditions can be improved by means of broader screening and expanded access to specialty consultations through telemedicine/telehealth, along with broader use of long-acting medications for the treatment of human immunodeficiency virus and SUDs. Expanding telemedicine/telehealth, first for specialties which do not require advanced technology (eg, infectious diseases, addictions), can eventually lead to further advancements in correctional healthcare.
Collapse
Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Brian T Montague
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Paul Trowbridge
- Spectrum Health Center for Integrative Medicine, Grand Rapids, Michigan, USA
| | - Steven C Johnson
- Division of Infectious Diseases, University of Colorado School of Medicine, Colorado, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Colorado Permanente Medical Group, Denver, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
54
|
Abdel-Samad M, Calzo JP, Felner JK, Urada L, Verbyla ME, Madanat H, Adams BE, Alves T, Appleyard B, Chanin J, Flanigan S, Foad H, Ginsberg M, Higgins M, Ko E, Maher K, Mladenov N, Peattie P, Welsh M, Sleet D. Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042020. [PMID: 33669672 PMCID: PMC7921968 DOI: 10.3390/ijerph18042020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.
Collapse
Affiliation(s)
- Mounah Abdel-Samad
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
- Correspondence:
| | - Jerel P. Calzo
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Jennifer K. Felner
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Lianne Urada
- School of Social Work, SDSU, San Diego, CA 92182, USA; (L.U.); (E.K.)
| | - Matthew E. Verbyla
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Hala Madanat
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Brian E. Adams
- Department of Political Science, SDSU, San Diego, CA 92182, USA; (B.E.A.); (K.M.)
| | - Thais Alves
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Bruce Appleyard
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Joshua Chanin
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Shawn Flanigan
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Hisham Foad
- Department of Economics, SDSU, San Diego, CA 92182, USA;
| | - Maya Ginsberg
- School of Music and Dance, SDSU, San Diego, CA 92182, USA;
| | | | - Eunjeong Ko
- School of Social Work, SDSU, San Diego, CA 92182, USA; (L.U.); (E.K.)
| | - Kristen Maher
- Department of Political Science, SDSU, San Diego, CA 92182, USA; (B.E.A.); (K.M.)
| | - Natalie Mladenov
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Peggy Peattie
- School of Journalism and Media Studies, SDSU, San Diego, CA 92182, USA;
| | - Megan Welsh
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - David Sleet
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| |
Collapse
|
55
|
|
56
|
Ly TDA, Castaneda S, Hoang VT, Dao TL, Gautret P. Vaccine-preventable diseases other than tuberculosis, and homelessness: A scoping review of the published literature, 1980 to 2020. Vaccine 2021; 39:1205-1224. [PMID: 33509694 DOI: 10.1016/j.vaccine.2021.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Homelessness may result in the breakdown of regular health services, including routine vaccination programmes. A scoping review was conducted to describe vaccine-preventable diseases (VPD) other than tuberculosis in people experiencing homelessness (PEH). METHODS We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched peer-reviewed literature published in English, French, Spanish or Portuguese reporting the outbreak of VPD or VPD prevalence in both infant and adult homeless populations published between 1980 and 2020, using PubMed/Medline, SciELO, Google Scholar, and Web of Science databases. Relevant information from the studies was charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Eighty-one articles were included. A high prevalence of past hepatitis B virus (HBV) and hepatitis A virus (HAV) infections were observed through serosurveys, mostly in high income countries or high-middle income countries (USA, Canada, France, Iran or Brazil). Ten outbreaks of HAV infection were also reported, with lethality rates ranging from 0 to 4.8%. The studies identified numerous risk factors positively associated with HBV infection, including older age, homosexual or bisexual practice, injected drug use (IDU), and, with HAV infection including IDU, having sexual partner(s) with a history of unspecified hepatitis, insertive anal penetration, or originating from a country with a high prevalence of anti-HAV antibody. Eleven outbreaks of pneumococcal infection affecting PEH were reported in Canada and USA, with lethality rates from 0 to 15.6%. Six diphtheria outbreaks were reported. Vaccination status was rarely documented in these studies. CONCLUSIONS The literature suggests that homeless populations generally experience a high VPD burden suggesting the need for a national vaccination programme and planning for delivering vaccines in this population.
Collapse
Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | | | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Pneumology Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
| |
Collapse
|
57
|
Prasoppokakorn T, Vanichanan J, Chaiteerakij R, Jutivorakool K, Udomkarnjananun S, Pongpirul K, Taesombat W, Wattanatorn S, Avihingsanon Y, Tungsanga K, Eiam-Ong S, Praditpornsilpa K, Townamchai N. A randomized controlled trial of comparative effectiveness between the 2 dose and 3 dose regimens of hepatitis a vaccine in kidney transplant recipients. Sci Rep 2021; 11:50. [PMID: 33420114 PMCID: PMC7794436 DOI: 10.1038/s41598-020-80052-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/16/2020] [Indexed: 01/07/2023] Open
Abstract
Hepatitis A virus (HAV) is able to cause a spectrum of illnesses ranging from no symptom to fulminant hepatitis which may lead to acute kidney injury. Although hepatitis A vaccine is recommended in non-immune solid organ transplant recipients who live in or travel to endemic areas, the standard 2-dose vaccination regimen demonstrated less favorable immunogenicity among these population. The 3-dose regimen showed higher response rate and immune durability in patients with human immunodeficiency virus. However, this strategy has never been studied in solid organ transplant recipients. A single-center, open-labeled, computer-based randomized controlled trial (RCT) with a 2:1 allocation ratio was conducted from August 2017 to December 2018. The study compared the seroconversion rate after receiving 2- or 3-dose regimen of hepatitis A vaccine at 0, 6 and 0, 1, 6 months, respectively, in non-immune kidney transplant recipients. A total of 401 adult kidney transplant recipients were screened for anti-HAV IgG and 285 subjects had positive results so the seroprevalence was 71.1%. Of 116 seronegative recipients, 93 (80.2%) completed vaccination; 60 and 33 participants completed 2- and 3-dose vaccination, respectively. The baseline characteristics were comparable between both groups. The seroconversion rate at 1 month after vaccination was 51.7% in the standard 2-dose regimen and 48.5% in the 3-dose regimen (p = 0.769). Overall, the seroconversion rate appeared to be associated with high estimated glomerular infiltration rate, high serum albumin, and low intensity immunosuppressive regimen. Seroconversion rate after hepatitis A vaccination in kidney transplant recipients was less favorable than healthy population. Three-dose regimen did not show superior benefit over the standard 2-dose regimen. Other strategies of immunization may increase immunogenicity among kidney transplant recipients.
Collapse
Affiliation(s)
- Thaninee Prasoppokakorn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jakapat Vanichanan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamonwan Jutivorakool
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Renal Immunology and Renal Transplant Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wipusit Taesombat
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Salin Wattanatorn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Renal Immunology and Renal Transplant Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Natavudh Townamchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. .,Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. .,Renal Immunology and Renal Transplant Research Unit, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
58
|
Seligman B, Ferranna M, Bloom DE. Social determinants of mortality from COVID-19: A simulation study using NHANES. PLoS Med 2021; 18:e1003490. [PMID: 33428624 PMCID: PMC7799807 DOI: 10.1371/journal.pmed.1003490] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. METHODS AND FINDINGS We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%-59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%-71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% -27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%-23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. CONCLUSIONS Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.
Collapse
Affiliation(s)
- Benjamin Seligman
- New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Maddalena Ferranna
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
59
|
Yin S, Barker L, Ly KN, Kilmer G, Foster MA, Drobeniuc J, Jiles RB. Susceptibility to Hepatitis A Virus Infection in the United States, 2007-2016. Clin Infect Dis 2020; 71:e571-e579. [PMID: 32193542 PMCID: PMC11009793 DOI: 10.1093/cid/ciaa298] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite national immunization efforts, including universal childhood hepatitis A (HepA) vaccination recommendations in 2006, hepatitis A virus (HAV)-associated outbreaks have increased in the United States. Unvaccinated or previously uninfected persons are susceptible to HAV infection, yet the susceptibility in the US population is not well known. METHODS Using National Health and Nutrition Examination Survey 2007-2016 data, we estimated HAV susceptibility prevalence (total HAV antibody negative) among persons aged ≥2 years. Among US-born adults aged ≥20 years, we examined prevalence, predictors, and age-adjusted trends of HAV susceptibility by sociodemographic characteristics. We assessed HAV susceptibility and self-reported nonvaccination to HepA among risk groups and the "immunization cohort" (those born in or after 2004). RESULTS Among US-born adults aged ≥20 years, HAV susceptibility prevalence was 74.1% (95% confidence interval, 72.9-75.3%) during 2007-2016. Predictors of HAV susceptibility were age group 30-49 years, non-Hispanic white/black, 130% above the poverty level, and no health insurance. Prevalences of HAV susceptibility and nonvaccination to HepA, respectively, were 72.9% and 73.1% among persons who reported injection drug use, 67.5% and 65.2% among men who had sex with men, 55.2% and 75.1% among persons with hepatitis B or hepatitis C, and 22.6% and 25.9% among the immunization cohort. Susceptibility and nonvaccination decreased over time among the immunization cohort but remained stable among risk groups. CONCLUSIONS During 2007-2016, approximately three-fourths of US-born adults remained HAV susceptible. Enhanced vaccination efforts are critically needed, particularly targeting adults at highest risk for HAV infection, to mitigate the current outbreaks.
Collapse
Affiliation(s)
- Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laurie Barker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Greta Kilmer
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monique A Foster
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jan Drobeniuc
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth B Jiles
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
60
|
Medrzycki M, Kamili S, Purdy MA. Hepatitis A virus survival on drug paraphernalia. J Viral Hepat 2020; 27:1484-1494. [PMID: 32810349 DOI: 10.1111/jvh.13379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/09/2022]
Abstract
The ongoing hepatitis A outbreaks in multiple states in the United States have concerned public health authorities since March 2017. The outbreaks have spread throughout 30 states and include primarily persons who use drugs, including persons who inject drugs (PWID) and persons experiencing homelessness. Contaminated drug injection paraphernalia and sharing of these items could potentially aid in transmission of hepatitis A virus (HAV) among these populations. We examined HAV survival on drug paraphernalia frequently shared among PWIDs. The effect of low pH on HAV survival using citric acid, which is frequently used by PWIDs during dose preparation, was investigated. We compared the plaque assay results with those concurrently obtained by qRT-PCR to establish whether HAV RNA levels could be used as surrogates for plaque assay results. HAV suspended in minimal essential media at room temperature infected FRhK4 cells for more than 17 weeks. HAV remained viable in syringes/needles for up to 10 weeks depending on the gauge of the needles and the syringe dead volumes, and on cookers, tourniquets and cotton balls/filter surfaces for up to 4 weeks. HAV retained its infectivity for more than 10 weeks at pH as low as 2. In conclusion, our findings show that HAV survives and remains infective in or on injection drug use equipment for 1 to 10 weeks depending on the type of paraphernalia examined and environmental conditions. These findings suggest that contaminated drug paraphernalia can potentially facilitate the transmission of HAV within populations who share these items.
Collapse
Affiliation(s)
- Magdalena Medrzycki
- Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Saleem Kamili
- Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A Purdy
- Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
61
|
Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2020; 73:e3572-e3605. [PMID: 33225349 DOI: 10.1093/cid/ciaa1391] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.
Collapse
Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
62
|
Webb GW, Kelly S, Dalton HR. Hepatitis A and Hepatitis E: Clinical and Epidemiological Features, Diagnosis, Treatment, and Prevention. CLINICAL MICROBIOLOGY NEWSLETTER 2020; 42:171-179. [PMID: 33110280 PMCID: PMC7581387 DOI: 10.1016/j.clinmicnews.2020.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatitis A and E are both ancient diseases but have only been properly recognized as being caused by distinct pathogens in modern times. Despite significantly different genomic structures, both viruses employ remarkably similar strategies to avoid host detection and increase environmental transmission. There are millions of cases of acute viral hepatitis due to hepatitis A virus (HAV) and hepatitis E virus (HEV) each year, resulting in tens of thousands of deaths. The presentations can be clinically indistinguishable, but each virus also has a range of less common but more specific phenotypes. The epidemiology of HAV is complex, and is shifting in countries that are making improvements to public health and sanitation. HEV presents a significant public health challenge in resource-limited settings but has historically been incorrectly regarded as having little clinical relevance in industrialized countries.
Collapse
Affiliation(s)
- Glynn W Webb
- Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - Sophie Kelly
- Royal Liverpool University Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Harry R Dalton
- University of Manchester, Manchester, United Kingdom
- Retired Consultant, Department of Gastroenterology, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom
| |
Collapse
|
63
|
Shouval D. The History of Hepatitis A. Clin Liver Dis (Hoboken) 2020; 16:12-23. [PMID: 33042523 PMCID: PMC7538924 DOI: 10.1002/cld.1018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023] Open
Abstract
Watch an interview with the author.
Collapse
Affiliation(s)
- Daniel Shouval
- Liver UnitHadassah‐Hebrew University HospitalJerusalemIsrael
| |
Collapse
|
64
|
Oren E, Martinez L, Hensley RE, Jain P, Ahmed T, Purnajo I, Nara A, Tsou MH. Twitter Communication During an Outbreak of Hepatitis A in San Diego, 2016-2018. Am J Public Health 2020; 110:S348-S355. [PMID: 33001731 PMCID: PMC7532315 DOI: 10.2105/ajph.2020.305900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives. To examine how and what information is communicated via social media during an infectious disease outbreak.Methods. In the context of the 2016 through 2018 hepatitis A outbreak in San Diego County, California, we used a grounded theory-based thematic analysis that employed qualitative and quantitative approaches to uncover themes in a sample of public tweets (n = 744) from Twitter, a primary platform used by key stakeholders to communicate to the public during the outbreak.Results. Tweets contained both general and hepatitis A-specific information related to the outbreak, restatements of policy and comments critical of government responses to the outbreak, information with the potential to shape risk perceptions, and expressions of concern regarding individuals experiencing homelessness and their role in spreading hepatitis A. We also identified misinformation and common channels of content driving themes that emerged in our sample.Conclusions. Public health professionals may identify real-time public risk perceptions and concerns via social media during an outbreak and target responses that fulfill the informational needs of those who seek direction and reassurance during times of uncertainty.
Collapse
Affiliation(s)
- Eyal Oren
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Lourdes Martinez
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - R. Eliza Hensley
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Purva Jain
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Taufa Ahmed
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Intan Purnajo
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Atsushi Nara
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| | - Ming-Hsiang Tsou
- Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University
| |
Collapse
|
65
|
Nosocomial hepatitis A outbreak among healthcare workers and patients in a community hospital during an ongoing statewide outbreak. Infect Control Hosp Epidemiol 2020; 42:139-141. [PMID: 32880246 DOI: 10.1017/ice.2020.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations. DESIGN Case series. SETTING Community hospital. PARTICIPANTS Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018-January 10, 2019. METHODS HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped. RESULTS We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b. CONCLUSIONS A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.
Collapse
|
66
|
Figgatt M, Hildick-Smith J, Addish E, Coleman J, Benitez J, Freeland C, Alles S, Viner K, Johnson C, Kuncio D. Susceptibility to Hepatitis A and B Virus Among Clients at a Syringe Services Program in Philadelphia, 2018. Public Health Rep 2020; 135:691-699. [PMID: 32791034 DOI: 10.1177/0033354920943528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Although many people who use drugs meet criteria for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV), estimates of susceptibility (ie, lack of immunity) are not well established. This study sought to identify the prevalence of and characteristics associated with HAV and HBV susceptibility among people who use drugs attending an urban syringe services program. METHODS We initiated this seroprevalence study in 2018 among 438 clients of a syringe services program who met study criteria, including provision of a blood specimen and a self-reported history of drug use. We assessed HAV and HBV susceptibility and infection via serological testing. We examined associations between participant characteristics and serology status by using descriptive statistics and multivariable logistic regression models. RESULTS Of the initial 438 clients identified, 353 (80.6%) met study criteria. Of 352 participants with conclusive HAV test results, 48.6% (n = 171) were HAV susceptible; of 337 participants with conclusive HBV test results, 32.6% (n = 110) were HBV susceptible, 24.3% (n = 82) showed evidence of past or present HBV infection, and 43.0% (n = 145) had vaccine-derived immunity. Compared with participants born before 1970, participants born during 1980-1989 had 5.90 (95% CI, 2.42-14.40) times the odds of HAV susceptibility and 0.18 (95% CI, 0.06-0.53) times the odds of HBV susceptibility, and participants born during 1990-1999 had 6.31 (95% CI, 2.34-17.00) times the odds of HAV susceptibility. Decreased odds of HAV susceptibility were associated with homelessness (adjusted odds ratio = 0.48; 95% CI, 0.28-0.82). CONCLUSION Despite applicable HAV and HBV vaccination recommendations, substantial gaps exist in HAV and HBV susceptibility among a population of people who use drugs. These findings highlight the need for increased HAV and HBV vaccination efforts among people who use drugs.
Collapse
Affiliation(s)
- Mary Figgatt
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | | | - Eman Addish
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | | | - José Benitez
- Prevention Point Philadelphia, Philadelphia, PA, USA
| | | | - Steven Alles
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kendra Viner
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Caroline Johnson
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Danica Kuncio
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| |
Collapse
|
67
|
Trooskin S, Jhaveri R. Conversations With the Editors: Hepatitis C Virus-Where are We Now and Where Do We Go From Here? Clin Ther 2020; 42:1425-1432. [PMID: 32778344 DOI: 10.1016/j.clinthera.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Stacey Trooskin
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Ravi Jhaveri
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
68
|
Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S, Koneru A, Haber P, Hagan L, Romero JR, Schillie S, Harris AM. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020; 69:1-38. [PMID: 32614811 PMCID: PMC8631741 DOI: 10.15585/mmwr.rr6905a1] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HEPATITIS A IS A VACCINE-PREVENTABLE, COMMUNICABLE DISEASE OF THE LIVER CAUSED BY THE HEPATITIS A VIRUS (HAV). THE INFECTION IS TRANSMITTED VIA THE FECAL-ORAL ROUTE, USUALLY FROM DIRECT PERSON-TO-PERSON CONTACT OR CONSUMPTION OF CONTAMINATED FOOD OR WATER. HEPATITIS A IS AN ACUTE, SELF-LIMITED DISEASE THAT DOES NOT RESULT IN CHRONIC INFECTION. HAV ANTIBODIES (IMMUNOGLOBULIN G [IGG] ANTI-HAV) PRODUCED IN RESPONSE TO HAV INFECTION PERSIST FOR LIFE AND PROTECT AGAINST REINFECTION; IGG ANTI-HAV PRODUCED AFTER VACCINATION CONFER LONG-TERM IMMUNITY. THIS REPORT SUPPLANTS AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) REGARDING THE PREVENTION OF HAV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS ROUTINE VACCINATION OF CHILDREN AGED 12-23 MONTHS AND CATCH-UP VACCINATION FOR CHILDREN AND ADOLESCENTS AGED 2-18 YEARS WHO HAVE NOT PREVIOUSLY RECEIVED HEPATITIS A (HEPA) VACCINE AT ANY AGE. ACIP RECOMMENDS HEPA VACCINATION FOR ADULTS AT RISK FOR HAV INFECTION OR SEVERE DISEASE FROM HAV INFECTION AND FOR ADULTS REQUESTING PROTECTION AGAINST HAV WITHOUT ACKNOWLEDGMENT OF A RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE GUIDANCE FOR VACCINATION BEFORE TRAVEL, FOR POSTEXPOSURE PROPHYLAXIS, IN SETTINGS PROVIDING SERVICES TO ADULTS, AND DURING OUTBREAKS.
Collapse
|
69
|
Haddix M, Civen R, Hacker JK, Probert W, New S, Green N, Hemarajata P, Gounder P. Use of Molecular Epidemiology to Inform Response to a Hepatitis A Outbreak - Los Angeles County, California, October 2018-April 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:820-824. [PMID: 32614812 PMCID: PMC7332094 DOI: 10.15585/mmwr.mm6926a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
70
|
Heavey E. Hepatitis A takes hold in the community. Nursing 2020; 50:24-28. [PMID: 32558785 DOI: 10.1097/01.nurse.0000668424.98515.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In 2016, large outbreaks of hepatitis A virus (HAV) infection began to occur among high-risk individuals, including those with a history of drug use and those experiencing homelessness. This article focusses on HAV infection among high-risk individuals in the community, including those experiencing homelessness.
Collapse
Affiliation(s)
- Elizabeth Heavey
- Elizabeth Heavey is graduate program director and professor of nursing at The College at Brockport, State University of New York in Brockport, N.Y., and a member of the Nursing2020 editorial board
| |
Collapse
|
71
|
"It's Just a Band-Aid on Something No One Really Wants to See or Acknowledge": A Photovoice Study with Transitional Aged Youth Experiencing Homelessness to Examine the Roots of San Diego's 2016-2018 Hepatitis A Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134721. [PMID: 32630063 PMCID: PMC7369867 DOI: 10.3390/ijerph17134721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 01/23/2023]
Abstract
San Diego, California is consistently ranked among regions with the highest rates of homelessness in the United States. From 2016 to 2018, San Diego experienced an unprecedented outbreak of hepatitis A virus (HAV), largely attributed in media and public health discourse to the region’s growing population of people experiencing homelessness. Little attention, however, was devoted to examining the experiences and needs of this population, particularly transitional aged youth (TAY, aged 18–24) experiencing homelessness who may have been uniquely affected by the outbreak. This community-based participatory research study leveraged diverse qualitative methods, principally photovoice, to explore how the social and built environment shapes health among TAY experiencing homelessness in San Diego, how these environments may have contributed to the HAV outbreak, and TAY’s perceptions of HAV-related public health interventions. Emergent findings include stigmatization of TAY and other people experiencing homelessness, interventions that failed to address root causes of the outbreak, and interactions with housing-related and other social support resources that limit rather than support economic and social mobility. Findings have implications for understanding how media and public discourse, public health interventions, and availability and delivery of resources can contribute to and perpetuate stigma and health inequities faced by TAY experiencing homelessness.
Collapse
|
72
|
Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterol Clin North Am 2020; 49:191-199. [PMID: 32389358 PMCID: PMC7883407 DOI: 10.1016/j.gtc.2020.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis A virus (HAV) is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Outbreaks are often linked to poor sanitation, overcrowding, or food and water contamination. Infection is often asymptomatic in children, but adults present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia. Diagnosis is through detection of immunoglobulin M antibodies against HAV, and treatment is supportive. Vaccination is the mainstay of prevention and should be given before exposure whenever possible.
Collapse
|
73
|
Abstract
Viral hepatitis (A, B, C, D, and E) is the leading cause of inflammation of liver tissue (hepatitis). The disease burden associated with hepatitis A and E occurs shortly after infection; it is more severe among adults. With hepatitis A and E, the number of incident cases (new acute infections) is important from a public health perspective. Long-term hepatitis has been shown to cause cirrhosis and hepatocellular carcinoma in patients. The disease burden associated with hepatitis B, C, and D appears 10 to 20 years after infection. Thus, the prevalence of these infections is important from a public health perspective.
Collapse
Affiliation(s)
- Homie Razavi
- Center for Disease Analysis Foundation, 1120 West South Boulder Road, Suite 102, Lafayette, CO 80026, USA.
| |
Collapse
|
74
|
Liu CY, Chai SJ, Watt JP. Communicable disease among people experiencing homelessness in California. Epidemiol Infect 2020; 148:e85. [PMID: 32223777 PMCID: PMC7189346 DOI: 10.1017/s0950268820000722] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/29/2020] [Accepted: 02/26/2020] [Indexed: 12/09/2022] Open
Abstract
California has a large population of people experiencing homelessness (PEH) that is characterised by a high proportion of people who are unsheltered and chronically homeless. PEH are at increased risk of communicable diseases due to multiple, intersecting factors, including increased exposures, comorbid conditions including substance use disorder and mental illness and lack of access to hygiene and healthcare facilities. Data available for several communicable diseases show that PEH in California experiences an increased burden of communicable diseases compared to people not experiencing homelessness. Public health agencies face unique challenges in serving this population. Efforts to reduce homelessness, increase access to health care for PEH, enhance data availability and strengthen partnerships among agencies serving PEH can help reduce the disparity in communicable disease burden faced by PEH.
Collapse
Affiliation(s)
- C. Y. Liu
- Kaiser Permanente San Francisco/University of California San Francisco Internal Medicine/Preventive Medicine Residency, San Francisco, USA
| | - S. J. Chai
- Division of Communicable Disease Control, California Department of Public Health, Richmond, California, USA
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. P. Watt
- Division of Communicable Disease Control, California Department of Public Health, Richmond, California, USA
| |
Collapse
|
75
|
Buechler CR, Ukani A, Elsharawi R, Gable J, Petersen A, Franklin M, Chung R, Bell J, Manly A, Hefzi N, Carpenter D, Bryce R. Barriers, beliefs, and practices regarding hygiene and vaccination among the homeless during a hepatitis A outbreak in Detroit, MI. Heliyon 2020; 6:e03474. [PMID: 32258449 PMCID: PMC7109626 DOI: 10.1016/j.heliyon.2020.e03474] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/25/2019] [Accepted: 02/10/2020] [Indexed: 01/15/2023] Open
Abstract
Appropriate hygiene practices and vaccine acceptance are key factors impacting the health of homeless individuals. A recent outbreak of hepatitis A in Michigan, especially impacting Detroit, prompted us to investigate the practices and attitudes of Detroit's homeless population toward hygiene measures and vaccinations, as well as barriers to such resources. We developed a questionnaire as a means to collect our data, and participants were interviewed at shelters and soup kitchens. While the majority of participants adhered to healthy hygiene practices, approximately 89% reported barriers to accessing public showers. More than half the participants (64%) reported receiving their hepatitis A vaccine prior to the study, while 23% reported previously refusing or hesitating to receive vaccinations. Despite an overall favorable adherence to hygiene practices, substantial barriers are yet to be overcome. Moreover, active measures should be taken to establish higher levels of trust between providers and the homeless to encourage vaccine acceptance.
Collapse
Affiliation(s)
- Connor R Buechler
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Anita Ukani
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Radwa Elsharawi
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Jessica Gable
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Anneliese Petersen
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Michael Franklin
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Raymond Chung
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Jedidiah Bell
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Amanda Manly
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Nousha Hefzi
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Dean Carpenter
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Neighborhood Service Organization, Detroit, Michigan, 48213, USA
| | - Richard Bryce
- Street Medicine Detroit, Detroit, Michigan, 48201, USA.,Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| |
Collapse
|
76
|
Hu X, Collier MG, Xu F. Hepatitis A Outbreaks in Developed Countries: Detection, Control, and Prevention. Foodborne Pathog Dis 2020; 17:166-171. [DOI: 10.1089/fpd.2019.2648] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xiaotong Hu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | | | - Fujie Xu
- The First Affiliated Hospital, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| |
Collapse
|
77
|
Probert WS, Gonzalez C, Espinosa A, Hacker JK. Molecular Genotyping of Hepatitis A Virus, California, USA, 2017-2018. Emerg Infect Dis 2019; 25:1594-1596. [PMID: 31310213 PMCID: PMC6649344 DOI: 10.3201/eid2508.181489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We implemented subgenomic and whole-genome sequencing to support the investigation of a large hepatitis A virus outbreak among persons experiencing homelessness, users of illicit drugs, or both in California, USA, during 2017-2018. Genotyping data helped confirm case-patients, track chains of transmission, and monitor the effectiveness of public health control measures.
Collapse
|
78
|
|
79
|
Community outbreak of hepatitis A disproportionately affecting men who have sex with men in Toronto, Canada, January 2017-November 2018. ACTA ACUST UNITED AC 2019; 45:262-268. [PMID: 31647057 DOI: 10.14745/ccdr.v45i10a03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background In late 2016 and early 2017, a number of countries began reporting hepatitis A virus (HAV) outbreaks involving person-to-person transmission among men who have sex with men (MSM), people using illicit drugs and homeless or underhoused persons. Objective To describe the epidemiology and public health response to an outbreak of HAV disproportionately affecting MSM in Toronto, Canada from January 2017 to November 2018. Methods Following an increase in the number of cases of HAV in MSM being reported in other countries, enhanced surveillance was performed for all non-travel-related cases of HAV reported from June 1, 2017 to November 1, 2018, including a retrospective analysis of cases reported from January 2017 to June 2017. Descriptive analysis and viral sequencing were performed to describe person-to-person transmission patterns and target interventions. Control strategies included interventions to promote the uptake of preexposure HAV vaccination, including social media campaigns geared to MSM, messaging to healthcare providers and vaccine clinics. Results Based on the outbreak case definitions, 52 confirmed and probable cases of HAV were identified. Over 80% of outbreak cases were male (n=43/52) and, among those for whom data were available, 64% (n=25/39) reported an MSM exposure. Data on hospitalization was available for 51 cases; 56% of confirmed cases (n=23/41) and 40% of probable cases (n=4/10) required hospitalization. Of the cases with serum samples that had HAV sequencing, 83% (n=30/36) had one of the three strains seen circulating in outbreaks among MSM internationally; 72% (n=26/36) were VRD_521_2016, which had been detected in recently reported European outbreaks among MSM. Targeted promotion of publicly-funded vaccination using social media platforms popular with MSM and targeted vaccine clinics were developed to promote HAV awareness and vaccine uptake among MSM. Conclusion Outbreaks of HAV, attributed to person-to-person transmission of strains of HAV that disproportionately affected MSM and were likely to have been imported from international MSM outbreaks, have now occurred in Canada. Genetic sequencing of HAV, risk factor analysis of cases, monitoring trends of vaccine coverage in high-risk groups and initiation of vaccination campaigns that address barriers to HAV preexposure vaccine coverage in the MSM population may prevent future outbreaks.
Collapse
|
80
|
Leibler JH, Liebschutz JM, Keosaian J, Stewart C, Monteiro J, Woodruff A, Stein MD. Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs. J Urban Health 2019; 96:734-740. [PMID: 31493182 PMCID: PMC6814663 DOI: 10.1007/s11524-019-00379-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a leading cause of hospitalization and medical visits among individuals experiencing homelessness and also among persons who inject drugs (PWID), populations with significant overlap in urban centers in the USA. While injection drug use is a risk factor for MRSA skin infections, MRSA is also known to transmit easily in crowded, public locations in which individuals have reduced personal hygiene. Individuals in urban centers who experience homelessness or drug addiction may spend significant amounts of time in environments where MRSA can be easily transmitted, and may also experience reduced access to facilities to maintain personal hygiene. We assessed the relationship between homelessness, personal hygiene, and MRSA nasal colonization, a proxy for MRSA infection risk, in a study of PWID in Boston, MA (n = 78). Sleeping in a homeless shelter for at least one night in the last 3 months was significantly associated with MRSA nasal colonization (OR 3.0; p = 0.02; 95% CI 1.2, 7.6). Sleeping at more than one place during the last week (considered a metric of elevated housing instability) was also associated with a threefold increase in odds of MRSA nasal colonization (OR 3.1; p = 0.01; 95% CI 1.3, 7.6). MRSA nasal colonization was strongly associated with use of public showers (OR 13.7; p = 0.02; 95% CI 1.4, 132.8), although few people in this study (4 of 78) reported using these public facilities. Sharing bedding with other people was also associated with increased risk of MRSA colonization (OR 2.2; p = 0.05; 95% CI 1.0-4.7). No associations between hand hygiene, frequency of bathing or clothes laundering, or street sleeping were observed. Use of public facilities supporting persons experiencing homelessness and housing instability, including shelters and public showers, is associated with an increased risk of MRSA nasal colonization in this study. Personal hygiene behaviors appear less associated with MRSA nasal colonization. Environmental assessments of MRSA contamination in homeless shelters and public sanitation facilities are warranted so as to inform appropriate intervention activities.
Collapse
Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Jane M Liebschutz
- Department of Medicine, Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia Keosaian
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Catherine Stewart
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jordanna Monteiro
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Alexander Woodruff
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
81
|
Koepke R, Sill DN, Akhtar WZ, Mitchell KP, Guilfoyle SM, Westergaard RP, Schauer SL, Vergeront JM. Hepatitis A and Hepatitis B Vaccination Coverage Among Persons Who Inject Drugs and Have Evidence of Hepatitis C Infection. Public Health Rep 2019; 134:651-659. [PMID: 31539482 PMCID: PMC6832086 DOI: 10.1177/0033354919874088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Despite recommendations for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) for all adults at increased risk of infection, several US states have reported increases in HAV and HBV infections among persons who inject drugs. We investigated hepatitis A and hepatitis B vaccination coverage among a sample of persons who reported injecting drugs and had evidence of hepatitis C virus (HCV) infection. METHODS We searched the Wisconsin Immunization Registry for the vaccination records of persons who underwent HCV testing at syringe services programs from January 1 through August 31, 2018, and were reported to the Wisconsin Division of Public Health as having positive HCV antibody test results and a history of injection drug use. We calculated the percentage of persons who were vaccinated according to national recommendations. RESULTS Of 215 persons reported, 204 (94.9%) had a client record in the Wisconsin Immunization Registry. Of these 204 persons, 66 (32.4%) had received ≥1 dose of hepatitis A vaccine, 46 (22.5%) had received 2 doses of hepatitis A vaccine, and 115 (56.4%) had received 3 doses of hepatitis B vaccine. Hepatitis B vaccine coverage decreased with increasing age, from 88.0% (22 of 25) among adults aged 20-24 to 30.3% (10 of 33) among adults aged 35-39. CONCLUSIONS These findings suggest that most persons who inject drugs in Wisconsin are susceptible to HAV infection and that most persons aged ≥35 who inject drugs are susceptible to HBV infection. In addition to routine vaccination of children, targeted hepatitis vaccination programs should focus on adults who inject drugs to help prevent future infections.
Collapse
Affiliation(s)
- Ruth Koepke
- Wisconsin Division of Public Health, Madison, WI, USA
- Division of Infectious Disease, Department of Medicine, University
of Wisconsin–Madison School of Medicine and Public Health, Madison, WI, USA
| | | | - Wajiha Z. Akhtar
- Division of Infectious Disease, Department of Medicine, University
of Wisconsin–Madison School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Ryan P. Westergaard
- Division of Infectious Disease, Department of Medicine, University
of Wisconsin–Madison School of Medicine and Public Health, Madison, WI, USA
| | | | | |
Collapse
|
82
|
Barrett CE, Pape BJ, Benedict KM, Foster MA, Roberts VA, Rotert K, Mattioli MC, Yoder JS. Impact of Public Health Interventions on Drinking Water–Associated Outbreaks of Hepatitis A — United States, 1971–2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:766-770. [DOI: 10.15585/mmwr.mm6835a4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
83
|
New Subgenotyping and Consensus Real-Time Reverse Transcription-PCR Assays for Hepatitis A Outbreak Surveillance. J Clin Microbiol 2019; 57:JCM.00500-19. [PMID: 31217273 DOI: 10.1128/jcm.00500-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Laboratory surveillance plays an important role in the detection and control of hepatitis A outbreaks and requires the application of rapid and accurate molecular diagnostic tools for hepatitis A virus (HAV) RNA detection, subgenotype identification, and sequence-based genotyping. We describe the development and validation of a triplex real-time, reverse transcription-PCR (triplex rRT-PCR) assay for the identification and discrimination of HAV subgenotypes IA, IB, and IIIA and a singleplex rRT-PCR assay designed to detect all HAV genotypes infecting humans. Overall, the accuracy, sensitivity, and specificity of the new assays were >97% for serum and plasma specimens collected during unrelated outbreaks of HAV in California and Michigan compared to a nested RT-PCR genotyping assay and the ISO 15216-1 rRT-PCR method for HAV detection. The new assays will permit the rapid detection of HAV RNA and discrimination among subgenotypes IA, IB, and IIIA in serum and plasma specimens, which will strengthen public health surveillance efforts for HAV outbreak detection and response.
Collapse
|
84
|
Huang S, Huang C, Wang N, Chen T, Lee Y, Lin S, Lin T, Lin C, Lee Y, Lee C, Chen C, Lin K, Chen G, Liu C, Cheng S, Lu P, Yang C, Hung C. Early Seroreversion After 2 Doses of Hepatitis A Vaccination in Human Immunodeficiency Virus-Positive Patients: Incidence and Associated Factors. Hepatology 2019; 70:465-475. [PMID: 30614542 PMCID: PMC6767446 DOI: 10.1002/hep.30495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
Serological responses (Seroresponse) and durability of hepatitis A virus (HAV) vaccination are reduced among human immunodeficiency virus (HIV)-positive patients. Incidence of and associated factors with early seroreversion (loss of seroresponse) among HIV-positive patients who have achieved seroresponses after two doses of HAV vaccination remain unclear. In this multicenter study, we followed HIV-positive adults who had mounted seroresponses after completing two doses of HAV vaccination during a recent outbreak of acute hepatitis A between 2015 and 2017, a 1:4 case-control study was conducted to identify factors associated with seroreversion. Case patients were those with seroreversion, and controls were those with similar follow-up durations who were able to maintain seroresponses. During the study period, 49 of the 1,256 patients (3.9%) seroreverted after a median follow-up of 611 days. In a case-control study, seroreversion was more likely to occur in patients with a higher weight (adjusted odds ratio [aOR], 1.703; 95% confidence interval [CI], 1.292-2.323, per 10-kg increment) and HIV viremia at the time of vaccination (aOR, 2.922; 95% CI, 1.067-7.924), whereas positive seroresponse at 6 months of HAV vaccination and higher CD4 lymphocyte counts at vaccination were inversely associated with early seroreversion with an aOR of 0.059 (95% CI, 0.020-0.154) and 0.837 (95% CI, 0.704-0.979, per 100-cell/mm3 increment), respectively, in multivariable analyses. Conclusion: During an outbreak setting, early seroreversion following two-dose HAV vaccination occurred in 3.9% of HIV-positive patients. Lower and delayed seroresponses to HAV vaccination, a higher weight, and HIV viremia and lower CD4 lymphocyte counts at the time of HAV vaccination were associated with early seroreversion. Regular monitoring of seroresponse and booster vaccination might be warranted, especially in HIV-positive adults with predictors of early seroreversion.
Collapse
Affiliation(s)
- Sung‐Hsi Huang
- Department of Internal MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsin‐ChuTaiwan,Department of Tropical Medicine and ParasitologyNational Taiwan University College of MedicineTaipeiTaiwan
| | - Chung‐Hao Huang
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Ning‐Chi Wang
- Department of Internal Medicine, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Tun‐Chieh Chen
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan,Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
| | - Yuan‐Ti Lee
- School of MedicineChung Shan Medical UniversityTaichungTaiwan,Department of Internal MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Shih‐Ping Lin
- Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Te‐Yu Lin
- Department of Internal Medicine, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Chi‐Ying Lin
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐LinTaiwan
| | - Yu‐Lin Lee
- Department of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Chen‐Hsiang Lee
- Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Cheng‐Pin Chen
- Department of Internal MedicineTaoyuan General Hospital, Ministry of Health and WelfareTaoyuanTaiwan
| | - Kuan‐Yin Lin
- Department of MedicineNational Taiwan University Hospital Jin‐Shan BranchNew Taipei CityTaiwan
| | - Guan‐Jhou Chen
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐LinTaiwan
| | - Chun‐Eng Liu
- Department of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Shu‐Hsing Cheng
- Department of Internal MedicineTaoyuan General Hospital, Ministry of Health and WelfareTaoyuanTaiwan,School of Public HealthTaipei Medical UniversityTaipeiTaiwan
| | - Po‐Liang Lu
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Chia‐Jui Yang
- Department of Internal MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan,School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Chien‐Ching Hung
- Department of Tropical Medicine and ParasitologyNational Taiwan University College of MedicineTaipeiTaiwan,Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | | |
Collapse
|
85
|
Sunshine G, Barrera N, Corcoran AJ, Penn M. Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:95-99. [PMID: 31298138 PMCID: PMC6644713 DOI: 10.1177/1073110519857328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.
Collapse
Affiliation(s)
- Gregory Sunshine
- Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona's Office of the Attorney General, where she practices public health law. Aubrey Joy's practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O'Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC's Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control's Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia
| | - Nancy Barrera
- Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona's Office of the Attorney General, where she practices public health law. Aubrey Joy's practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O'Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC's Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control's Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia
| | - Aubrey Joy Corcoran
- Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona's Office of the Attorney General, where she practices public health law. Aubrey Joy's practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O'Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC's Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control's Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia
| | - Matthew Penn
- Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona's Office of the Attorney General, where she practices public health law. Aubrey Joy's practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O'Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC's Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control's Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia
| |
Collapse
|
86
|
Schaefer EA, Anderson MA, Kim AY, Sfeir MM. Case 15-2019: A 55-Year-Old Man with Jaundice. N Engl J Med 2019; 380:1955-1963. [PMID: 31091378 DOI: 10.1056/nejmcpc1900592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Esperance A Schaefer
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Mark A Anderson
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Arthur Y Kim
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| | - Maroun M Sfeir
- From the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Massachusetts General Hospital, and the Departments of Medicine (E.A.S., A.Y.K.), Radiology (M.A.A.), and Pathology (M.M.S.), Harvard Medical School - both in Boston
| |
Collapse
|
87
|
Foster MA, Hofmeister MG, Kupronis BA, Lin Y, Xia GL, Yin S, Teshale E. Increase in Hepatitis A Virus Infections - United States, 2013-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:413-415. [PMID: 31071072 PMCID: PMC6542191 DOI: 10.15585/mmwr.mm6818a2] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Monique A Foster
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Megan G Hofmeister
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Benjamin A Kupronis
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Yulin Lin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Guo-Liang Xia
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Eyasu Teshale
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| |
Collapse
|
88
|
Andrievskaya M, Lenhart A, Uduman J. Emerging Threat: Changing Epidemiology of Hepatitis A and Acute Kidney Injury. Adv Chronic Kidney Dis 2019; 26:171-178. [PMID: 31202389 DOI: 10.1053/j.ackd.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/27/2022]
Abstract
In the past decade, hepatitis A has been considered a rare disease in the United States, largely due to targeted vaccination of at-risk children. Evolving epidemiology has resulted in decreasing immunity and increasing hepatitis A infections among adults who are more likely to experience severe disease. A surge in outbreaks has been noted in the past 2 years, resulting in a high volume of hepatitis A related hospitalizations and complications in otherwise healthy individuals. The traditional understanding that acute kidney injury is a rare extrahepatic manifestation is being challenged by the resurgence of hepatitis A in a more vulnerable population. This review examines the epidemiologic factors that contributed to current public health concern and the association between hepatitis A and acute kidney injury.
Collapse
|
89
|
Wilson E, Hofmeister MG, McBee S, Briscoe J, Thomasson E, Olaisen RH, Augustine R, Duncan E, Bamrah Morris S, Haddy L. Notes from the Field: Hepatitis A Outbreak Associated with Drug Use and Homelessness - West Virginia, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:330-331. [PMID: 30973849 PMCID: PMC6459581 DOI: 10.15585/mmwr.mm6814a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
90
|
The As and Bs of HIV and Hepatitis Co-Infection. Trop Med Infect Dis 2019; 4:tropicalmed4020055. [PMID: 30934708 PMCID: PMC6630421 DOI: 10.3390/tropicalmed4020055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
Hepatitis A and B co-infection among people living with HIV are public health challenges that account for an increasing degree of morbidity and mortality. Understanding the changing epidemiology, clinical manifestations, and new approaches to treatment and prevention continues to be important in the care of people living with HIV. We conducted a review of the literature that included studies on hepatitis A and HIV co-infection and hepatitis B and HIV co-infection, focusing on epidemiology, clinical manifestations, treatment, and prevention. Important updates include the changing epidemiology of hepatitis A outbreaks among the homeless and individuals who use substances, and novel approaches to hepatitis B vaccination and hepatitis B cure strategies.
Collapse
|
91
|
Bravo C, Mege L, Vigne C, Thollot Y. Clinical experience with the inactivated hepatitis A vaccine, Avaxim 80U Pediatric. Expert Rev Vaccines 2019; 18:209-223. [PMID: 30806110 DOI: 10.1080/14760584.2019.1580578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hepatitis A, caused by hepatitis A virus (HAV), is primarily transmitted via the fecal/oral route either through ingestion of contaminated food and water or through direct contact with an infectious person. Prevalence of hepatitis A is strongly correlated with socioeconomic factors, decreasing with increased socio-economic development, access to clean water and sanitation. Vaccination against HAV should be part of a comprehensive plan for the prevention and control of viral hepatitis, either as part of regular childhood immunization programs or with other recommended vaccines for travelers. Areas covered: We present here evidence for the immunogenicity and safety of an inactivated HAV pediatric vaccine (Avaxim® 80U Pediatric, Sanofi Pasteur), indicated for use in children aged 12 months to 15 years. Data evaluated are from trials undertaken during the clinical development of this vaccine, a systematic literature review and post-market pharmacovigilance. Expert opinion: The pediatric HAV vaccine is highly immunogenic and generates long-lasting protection against hepatitis A disease in children. The safety and immunogenicity data presented in this review suggest that the pediatric HAV vaccine is a valuable option in the prevention of HAV infection in children in many areas of the world where the disease remains a healthcare issue.
Collapse
Affiliation(s)
| | - Larissa Mege
- b Global Pharmacovigilance , Sanofi Pasteur , Marcy-l'Étoile , France
| | - Claire Vigne
- c Research & Development , Sanofi Pasteur , Marcy-l'Étoile , France
| | - Yael Thollot
- a Global Medical Affairs , Sanofi Pasteur , Lyon , France
| |
Collapse
|
92
|
Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:153-156. [PMID: 30763295 PMCID: PMC6375653 DOI: 10.15585/mmwr.mm6806a6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatitis A (HepA) vaccination is recommended routinely for children at age 12-23 months, for persons who are at increased risk for hepatitis A virus (HAV) infection, and for any person wishing to obtain immunity. Persons at increased risk for HAV infection include international travelers to areas with high or intermediate hepatitis A endemicity, men who have sex with men, users of injection and noninjection drugs, persons with chronic liver disease, person with clotting factor disorders, persons who work with HAV-infected primates or with HAV in a research laboratory setting, and persons who anticipate close contact with an international adoptee from a country of high or interme-diate endemicity (1-3). Persons experiencing homelessness are also at higher risk for HAV infection and severe infection-associated outcomes. On October 24, 2018, the Advisory Committee on Immunization Practices (ACIP)* recommended that all persons aged 1 year and older experiencing homelessness be routinely immunized against HAV. The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine to persons experiencing homelessness, which included a set of criteria assessing the benefits and adverse events associated with vaccination. HepA vaccines are highly immunogenic, and >95% of immunocompetent adults develop protective antibody within 4 weeks of receipt of 1 dose of the vaccine (1). HAV infections are acquired primarily by the fecal-oral route by either person-to-person transmission or via ingestion of contaminated food or water. Among persons experiencing homelessness, effective implementation of alternative strategies to prevent exposure to HAV, such as strict hand hygiene, is difficult because of living conditions among persons in this population. Integrating routine HepA vaccination into health care services for persons experiencing homelessness can reduce the size of the at-risk population over time and thereby reduce the risk for large-scale outbreaks.
Collapse
|