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Horn EK, Herrera-Restrepo O, Acosta AM, Simon A, Jackson B, Lucas E. The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies. J Infect Dis 2024; 230:e199-e218. [PMID: 39052742 PMCID: PMC11272058 DOI: 10.1093/infdis/jiae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Hepatitis A (HepA) vaccines are recommended for US adults at risk of HepA. Ongoing United States (US) HepA outbreaks since 2016 have primarily spread person-to-person, especially among at-risk groups. We investigated the health outcomes, economic burden, and outbreak management considerations associated with HepA outbreaks from 2016 onwards. METHODS A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations. RESULTS Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness. CONCLUSIONS This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.
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Patanwala MY, Garcia CM, Kushel M. Health Care for People Experiencing Homelessness. JAMA 2024; 332:70-71. [PMID: 38837140 DOI: 10.1001/jama.2024.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
This JAMA Insights examines the adverse effects of homelessness on physical and mental health and suggests strategies to improve access to health care, services, and housing for people experiencing homelessness.
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Affiliation(s)
- Maria Y Patanwala
- San Francisco Department of Public Health, San Francisco, California
| | - Cheyenne M Garcia
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco
| | - Margot Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco
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Graf W, Bertram F, Dost K, Brennecke A, Kowalski V, van Rüth V, Nörz DS, Wulff B, Ondruschka B, Püschel K, Pfefferle S, Lütgehetmann M, Heinrich F. Immunity against measles, mumps, rubella, and varicella among homeless individuals in Germany - A nationwide multi-center cross-sectional study. Front Public Health 2024; 12:1375151. [PMID: 38784578 PMCID: PMC11111963 DOI: 10.3389/fpubh.2024.1375151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Homeless individuals suffer a high burden of vaccine-preventable infectious diseases. Moreover, they are particularly susceptible to adverse infection outcomes with limited access to the health care system. Data on the seroprevalence of measles, mumps, rubella, and varicella within this cohort are missing. Methods The seroprevalence of measles, mumps, rubella, and varicella was determined within the homeless population in Germany. Predictors of lacking immune protection were determined using multivariable logistic regression analysis. Results Homeless individuals in Germany (n = 611) showed a seroprevalence of 88.5% (95% CI: 85.8-91.0) for measles, 83.8% (95% CI: 80.6-86.6) for mumps, 86.1% (95% CI: 83.1-88.7) for rubella, and 95.7% (95% CI 93.8-97.2) for varicella. Measles seroprevalences declined from individuals born in 1965 to individuals born in 1993, with seroprevalences not compatible with a 95% threshold in individuals born after 1980. For mumps, seroprevalences declined from individuals born in 1950 to individuals born in 1984. Here, seroprevalences were not compatible with a 92% threshold for individuals born after 1975. Seronegativity for measles, mumps and rubella was associated with age but not with gender or country of origin. Discussion Herd immunity for measles and mumps is not achieved in this homeless cohort, while there was sufficient immune protection for rubella and varicella. Declining immune protection rates in younger individuals warrant immunization campaigns also targeting marginalized groups such as homeless individuals. Given that herd immunity thresholds are not reached for individuals born after 1980 for measles, and after 1975 for mumps, vaccination campaigns should prioritize individuals within these age groups.
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Affiliation(s)
- Wiebke Graf
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Dost
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Brennecke
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Veronika Kowalski
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Sebastian Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pfefferle
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Center for Data and Statistical Science for Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Yang J, Lo NC, Dankwa EA, Donnelly CA, Gupta R, Montgomery MP, Weng MK, Martin NK. Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States. Clin Infect Dis 2024; 78:976-982. [PMID: 37738564 PMCID: PMC11006109 DOI: 10.1093/cid/ciad552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Widespread outbreaks of person-to-person transmitted hepatitis A virus (HAV), particularly among people who inject drugs (PWID), continue across the United States and globally. However, the herd immunity threshold and vaccination coverage required to prevent outbreaks are unknown. We used surveillance data and dynamic modeling to estimate herd immunity thresholds among PWID in 16 US states. METHODS We used a previously published dynamic model of HAV transmission calibrated to surveillance data from outbreaks involving PWID in 16 states. Using state-level calibrated models, we estimated the basic reproduction number (R0) and herd immunity threshold for PWID in each state. We performed a meta-analysis of herd immunity thresholds to determine the critical vaccination coverage required to prevent most HAV outbreaks among PWID. RESULTS Estimates of R0 for HAV infection ranged from 2.2 (95% confidence interval [CI], 1.9-2.5) for North Carolina to 5.0 (95% CI, 4.5-5.6) for West Virginia. Corresponding herd immunity thresholds ranged from 55% (95% CI, 47%-61%) for North Carolina to 80% (95% CI, 78%-82%) for West Virginia. Based on the meta-analysis, we estimated a pooled herd immunity threshold of 64% (95% CI, 61%-68%; 90% prediction interval, 52%-76%) among PWID. Using the prediction interval upper bound (76%) and assuming 95% vaccine efficacy, we estimated that vaccination coverage of 80% could prevent most HAV outbreaks. CONCLUSIONS Hepatitis A vaccination programs in the United States may need to achieve vaccination coverage of at least 80% among PWID in order to prevent most HAV outbreaks among this population.
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Affiliation(s)
- Judy Yang
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuelle A Dankwa
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Ribhav Gupta
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martha P Montgomery
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark K Weng
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Ohlsen EC, Angel K, Maroufi A, Kao A, Victorio MJ, Cua LS, Kimura A, Vanden Esschert K, Logan N, McMichael TM, Beatty ME, Shah S. Shigellosis outbreak among persons experiencing homelessness-San Diego County, California, October-December 2021. Epidemiol Infect 2023; 152:e61. [PMID: 37869979 PMCID: PMC11062786 DOI: 10.1017/s0950268823001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
During October 2021, the County of San Diego Health and Human Services Agency identified five cases of shigellosis among persons experiencing homelessness (PEH). We conducted an outbreak investigation and developed interventions to respond to shigellosis outbreaks among PEH. Confirmed cases occurred among PEH with stool-cultured Shigella sonnei; probable cases were among PEH with Shigella-positive culture-independent diagnostic testing. Patients were interviewed to determine infectious sources and risk factors. Fifty-three patients were identified (47 confirmed, 6 probable); 34 (64%) were hospitalised. None died. No point source was identified. Patients reported inadequate access to clean water and sanitation facilities, including public restrooms closed because of the COVID-19 pandemic. After implementing interventions, including handwashing stations, more frequent public restroom cleaning, sanitation kit distribution, and isolation housing for ill persons, S. sonnei cases decreased to preoutbreak frequencies. Improving public sanitation access was associated with decreased cases and should be considered to prevent outbreaks among PEH.
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Affiliation(s)
- Elizabeth C Ohlsen
- Epidemic Intelligence Service, San Diego, CA, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Angel
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Azarnoush Maroufi
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Annie Kao
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Maria J Victorio
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Lynnie S Cua
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Akiko Kimura
- California Department of Public Health, Richmond, CA, USA
| | | | - Naeemah Logan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Temet M McMichael
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Mark E Beatty
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Seema Shah
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
- University of California San Diego, San Diego, CA, USA
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Crane M, Joly L, Daly BJ, Gage H, Manthorpe J, Cetrano G, Ford C, Williams P. Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-217. [PMID: 37839804 DOI: 10.3310/wxuw5103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services. Objectives This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants' use of health care and social care services over 12 months, and costs were calculated. Design and setting The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model. Participants People who had been homeless during the previous 12 months were recruited as 'case study participants'; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders. Results The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services. Limitations There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model. Conclusions Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, 'drop-in' services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (HSDR 13/156/03) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maureen Crane
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Louise Joly
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Blánaid Jm Daly
- Special Care Dentistry, Division of Population and Patient Health, King's College London, London, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Jill Manthorpe
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Gaia Cetrano
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
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Fallucca A, Restivo V, Sgariglia MC, Roveta M, Trucchi C. Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review. Vaccines (Basel) 2023; 11:1271. [PMID: 37515087 PMCID: PMC10383099 DOI: 10.3390/vaccines11071271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The hepatitis A virus (HAV) is still a leading cause of viral hepatitis worldwide. After a long incubation period, the clinical manifestations range from asymptomatic infection to acute liver failure. The severity of the disease increases with age and pre-existing liver disease. The transmission is mainly via person-to-person contact or ingestion of contaminated food or water. Food contamination can occur at any step of the food chain, especially when infected people handle not-heated or otherwise-treated food. HAV is endemic in low-income countries because of poor sanitary and sociodemographic conditions. The populations of developed countries are highly susceptible, and large outbreaks occur when HAV is introduced from endemic countries due to globalization, travel, and movement of foodstuffs. HAV prevention includes hygiene practices, immunoglobulins, and vaccination. Safe and effective inactivated and live attenuated vaccines are available and provide long-term protection. The vaccine targets are children and subjects at increased risk of HAV exposure or serious clinical outcomes. This review discusses the critical role of food handlers in the spread of HAV and the opportunity for food industry employers to consider food handler immunization a tool to manage both food safety in compliance with HACCP principles and food operators' biologic risk.
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Affiliation(s)
- Alessandra Fallucca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | | | - Marco Roveta
- Food Hygiene and Nutrition Service, Department of Prevention, Local Health Unit 3, 16142 Genoa, Italy
| | - Cecilia Trucchi
- Food Hygiene and Nutrition Service, Department of Prevention, Local Health Unit 3, 16142 Genoa, Italy
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Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4263309. [PMID: 36644336 PMCID: PMC9833905 DOI: 10.1155/2023/4263309] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
Hepatitis A virus (HAV) is one of the well-known viruses that cause hepatitis all around the globe. Although this illness has decreased in developed countries due to extensive immunization, numerous developing and under-developed countries are struggling with this virus. HAV infection can be spread by oral-fecal contact, and there are frequent epidemics through nutrition. Improvements in socioeconomic and sanitary circumstances have caused a shift in the disease's prevalence worldwide. Younger children are usually asymptomatic, but as they become older, the infection symptoms begin to appear. Symptoms range from slight inflammation and jaundice to acute liver failure in older individuals. While an acute infection may be self-limiting, unrecognized persistent infections, and the misapplication of therapeutic methods based on clinical guidelines are linked to a higher incidence of cirrhosis, hepatocellular carcinoma, and mortality. Fortunately, most patients recover within two months of infection, though 10-15% of patients will relapse within the first six months. A virus seldom leads to persistent infection or liver damage. The mainstay of therapy is based on supportive care. All children from 12-23 months, as well as some susceptible populations, should receive routine vaccinations, according to the Centers for Disease Control and Prevention and the American Academy of Pediatrics. Laboratory diagnosis of HAV is based on antigen detection, checking liver enzyme levels, and antibody screening. Furthermore, polymerase chain reaction (PCR) technology has identified HAV in suspected nutrition sources; therefore, this technique is used for preventative measures and food-related laws.
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Zhu A, Bruketa E, Svoboda T, Patel J, Elmi N, El-Khechen Richandi G, Baral S, Orkin AM. Respiratory infectious disease outbreaks among people experiencing homelessness: a systematic review of prevention and mitigation strategies. Ann Epidemiol 2023; 77:127-135. [PMID: 35342013 DOI: 10.1016/j.annepidem.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE People experiencing homelessness (PEH) are at increased risk of respiratory infections and associated morbidity and mortality. To characterize optimal intervention strategies, we completed a systematic review of mitigation strategies for PEH to minimize the spread and impact of respiratory infectious disease outbreaks, including COVID-19. METHODS The study protocol was registered in PROSPERO (#2020 CRD42020208964) and was consistent with the preferred reporting in systematic reviews and meta-analyses guidelines. A search algorithm containing keywords that were synonymous to the terms "Homeless" and "Respiratory Illness" was applied to the six databases. The search concluded on September 22, 2020. Quality assessment was performed at the study level. Steps were conducted by two independent team members. RESULTS A total of 4468 unique titles were retrieved with 21 meeting criteria for inclusion. Interventions included testing, tracking, screening, infection prevention and control, isolation support, and education. Historically, there has been limited study of intervention strategies specifically for PEH across the world. CONCLUSIONS Staff and organizations providing services for people experiencing homelessness face specific challenges in adhering to public health guidelines such as physical distancing, isolation, and routine hygiene practices. There is a discrepancy between the burden of infectious diseases among PEH and specific research characterizing optimal intervention strategies to mitigate transmission in the context of shelters. Improving health for people experiencing homelessness necessitates investment in programs scaling existing interventions and research to study new approaches.
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Affiliation(s)
- Alice Zhu
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Department of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Eva Bruketa
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Queen's University, School of Medicine, Kingston, ON, Canada
| | - Tomislav Svoboda
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada
| | - Jamie Patel
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Ryerson University, Daphne Cockwell School of Nursing, Toronto, ON, Canada
| | - Nika Elmi
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Stefan Baral
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Aaron M Orkin
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, ON, Canada.
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Herrera-Restrepo O, Davis K, Sweeney C, Davenport E, Ghaswalla P, Buck PO. Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers' attitudes and practices. Hum Vaccin Immunother 2022; 18:2123180. [PMID: 36287135 PMCID: PMC9746442 DOI: 10.1080/21645515.2022.2123180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This study aimed to evaluate the attitudes and practices of US healthcare professionals (HCPs) regarding the Advisory Committee on Immunization Practices (ACIP) vaccination recommendations on HepA and HepB for adult patients at risk of contracting these infections or experiencing complications of hepatitis disease. This cross-sectional, web-based survey of 400 US HCPs, which included nurse practitioners and family medicine, internal medicine, infectious disease, emergency department, and gastroenterology physicians, assessed HCPs' attitudes and practices regarding the ACIP recommendations for adult patients at risk for hepatitis disease. HCP participants were identified via a survey research panel. A recruitment quota of 400 HCPs was set, including 50 NPs, 100 FMs, 100 IMs, 50 GIs, 50 EDs, and 50 IDs. The most frequently reported reasons for not recommending either HepA or HepB vaccines were "I think the risk of HepA infection is low in this patient population" and "I am uncertain about what the guidelines say about vaccinating this population." The most reported factors considered when determining eligibility for either vaccine were medical history and the patient's willingness/motivation to be vaccinated. Most reported it was extremely or moderately important to prevent hepatitis disease by vaccinating adult patients at risk, and most also reported recommending a HepA vaccine or HepB vaccine to patients at risk. Although most HCPs reported recommending HepA and HepB vaccines to patients at risk, these findings contrast with the low reported vaccination rates among these populations, and improved awareness of the ACIP recommendations among HCPs is needed.
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Affiliation(s)
- Oscar Herrera-Restrepo
- US Health Outcomes, Vaccines, GSK, Philadelphia, PA, USA,CONTACT Oscar Herrera-Restrepo US Health Outcomes, Vaccines, GSK, FMC Tower Suite 1700, 2929 Walnut Street, Philadelphia, PA19104, USA
| | - Kimberly Davis
- Surveys and Observational Studies, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Carolyn Sweeney
- Surveys and Observational Studies, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Eric Davenport
- Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Philip O. Buck
- US Health Outcomes, Vaccines, GSK, Philadelphia, PA, USA
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11
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Mashhadi A, Khalili M, Moghaddam AA, Zadehmir M. Prognostic Value of Porta-Hepatis Lymphadenopathy in Children with Hepatitis A. J Med Ultrasound 2022; 30:272-276. [PMID: 36844764 PMCID: PMC9944826 DOI: 10.4103/jmu.jmu_196_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background The present study aimed to investigate the prognostic value of porta-hepatis lymphadenopathy (PHL) in children with hepatitis A virus. Methods The present prospective cohort study included 123 pediatric patients with a definite diagnosis of hepatitis A who were divided into two groups based on the presence or absence of PHL in their abdominal ultrasound: Group A included the patients with a porta-hepatis lymph node of >6 mm in diameter, whereas the patients with a porta-hepatis lymph node of <6 mm in diameter were classified in Group B. The patients were also classified based on the presence or absence of para-aortic lymphadenopathy: Group C had bisecting para-aortic lymph nodes, whereas Group D did not have such findings in their ultrasound. Afterward, the groups were compared in laboratory investigation results and hospital stay. Results According to our results, Group A (n = 57) was significantly higher in aspartate and alanine aminotransferase and alkaline phosphatase levels compared to Group B (P < 0.05), whereas these two groups were not significantly different in the hospital stay. Furthermore, except bilirubin, all laboratory test results were significantly higher in Group C (n = 3) than in Group D. However, there was no significant correlation between the patients' prognosis with the absence or presence of porta-hepatis or para-aortic lymphadenopathy. Conclusion We concluded that there was no significant relationship between porta-hepatis or para-aortic lymphadenopathy and the prognosis of the children with hepatitis A. However, ultrasound findings can help determine the disease severity in pediatric patients with hepatitis A.
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Affiliation(s)
- Amin Mashhadi
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Manijeh Khalili
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
| | - Alireza Ansari Moghaddam
- Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohadeseh Zadehmir
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran,Address for correspondence: Dr. Mohadeseh Zadehmir, Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. E-mail:
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12
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McCosker LK, El-Heneidy A, Seale H, Ware RS, Downes MJ. Strategies to improve vaccination rates in people who are homeless: A systematic review. Vaccine 2022; 40:3109-3126. [PMID: 35484042 PMCID: PMC9040475 DOI: 10.1016/j.vaccine.2022.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 10/28/2022]
Abstract
People who are homeless experience higher rates of vaccine-preventable disease, including COVID-19, than the general population, and poorer associated health outcomes. However, delivering vaccinations to people who are homeless is complex, and there is a lack of evidence to inform practice in this area. The aim of this systematic review is to: (a) identify, (b) analyse the characteristics of, and (c) evaluate the outcomes of, strategies to improve vaccination rates in people who are homeless. Literature was retrieved from eight electronic databases. Studies undertaken in high-income countries, published in English, in a peer-reviewed journal, and in full-text were considered. No limits were placed on study design or date. A total of 1,508 articles were retrieved and, after the removal of duplicates, 637 were screened. Twenty-three articles, reporting on nineteen separate vaccination strategies for hepatitis A/B, influenza, herpes zoster, invasive pneumococcal disease, and diphtheria in people who are homeless, were selected for inclusion. All the strategies were effective at improving vaccination rates in, people who are homeless. Most strategies involved vaccination clinics and most were delivered, at least in part, by nurses. Other characteristics of successful strategies included: delivering vaccinations at convenient locations; using accelerated vaccination schedules (if available); vaccinating at the first appointment, regardless of whether a person's vaccination history or serological status were known (if clinically safe); operating for a longer duration; offering training to staff about working with people who are homeless; widely promoting clinics; considering education, reminders, incentives, and co-interventions; ensuring no out-of-pocket costs; and working collaboratively with stakeholders, including people who are homeless themselves. These findings will inform evidence-based vaccination strategies, including for COVID-19, in people who are homeless, and improve associated health outcomes in this at-risk, hard-to-reach group.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Population Health, University of New South Wales, Australia.
| | - Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
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13
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Aranda-Díaz A, Imbert E, Strieff S, Graham-Squire D, Evans JL, Moore J, McFarland W, Fuchs J, Handley MA, Kushel M. Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters. PLoS One 2022; 17:e0264929. [PMID: 35271622 PMCID: PMC8912252 DOI: 10.1371/journal.pone.0264929] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. Methods We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. Results Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project’s initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. Conclusion Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.
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Affiliation(s)
- Andrés Aranda-Díaz
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Elizabeth Imbert
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
| | - Sarah Strieff
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Dave Graham-Squire
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jennifer L. Evans
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jamie Moore
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jonathan Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Margaret A. Handley
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- UCSF PRISE Center: Partnerships for Research in Implementation Science for Equity, San Francisco, California, United States of America
| | - Margot Kushel
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
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14
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Kozak RA, Rutherford C, Richard-Greenblatt M, Chau NYE, Cabrera A, Biondi M, Borlang J, Day J, Osiowy C, Ramachandran S, Mayer N, Glaser L, Smieja M. Development and Evaluation of a Molecular Hepatitis A Virus Assay for Serum and Stool Specimens. Viruses 2022; 14:v14010159. [PMID: 35062362 PMCID: PMC8777614 DOI: 10.3390/v14010159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
Abstract
Hepatitis A virus (HAV) is an emerging public health concern and there is an urgent need for ways to rapidly identify cases so that outbreaks can be managed effectively. Conventional testing for HAV relies on anti-HAV IgM seropositivity. However, studies estimate that 10–30% of patients may not be diagnosed by serology. Molecular assays that can directly detect viral nucleic acids have the potential to improve diagnosis, which is key to prevent the spread of infections. In this study, we developed a real-time PCR (RT-PCR) assay to detect HAV RNA for the identification of acute HAV infection. Primers were designed to target the conserved 5′-untranslated region (5′-UTR) of HAV, and the assay was optimized on both the Qiagen Rotor-Gene and the BD MAX. We successfully detected HAV from patient serum and stool samples with moderate differences in sensitivity and specificity depending on the platform used. Our results highlight the clinical utility of using a molecular assay to detect HAV from various specimen types that can be implemented in hospitals to assist with diagnostics, treatment and prevention.
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Affiliation(s)
- Robert A. Kozak
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Candace Rutherford
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
| | - Melissa Richard-Greenblatt
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - N. Y. Elizabeth Chau
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Ana Cabrera
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Mia Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M6H 3M1, Canada;
| | - Jamie Borlang
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Jaqueline Day
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Carla Osiowy
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Sumathi Ramachandran
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Nancy Mayer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Laurel Glaser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Marek Smieja
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Correspondence: ; Tel.: +1-905-521-6083
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15
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Wurcel AG, Chen G, Zubiago JA, Reyes J, Nowotny KM. Heterogeneity in Jail Nursing Medical Intake Forms: A Content Analysis. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:265-271. [PMID: 34724807 DOI: 10.1089/jchc.20.04.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Despite high prevalence of infectious diseases and substance use disorders in jails, there are limited guidelines for the nursing intake process in this setting. We performed a content analysis of nursing intake forms used at each of the 14 Massachusetts county jails, focusing on infectious disease and substance use disorder. Only 85% of jails offered HIV testing during nursing intake and 50% of jails offered hepatitis C testing. Preventive interventions such as vaccines or pre-exposure prophylaxis therapy were infrequently offered during nursing intake. Screening for substance use disorder was present on the majority of intake forms, but only 23% of intake forms inquired about ongoing medication-assisted treatment for opioid use disorder. The results reflect heterogeneity in nursing intake forms, highlighting missed opportunities for public health interventions.
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Affiliation(s)
- Alysse G Wurcel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gang Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia A Zubiago
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica Reyes
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
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16
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Reichenbach ZW, Hogan C, Piech G, Shah S, Lambrou T, Radcliffe M, Kiani A, Peng L. Characterization of a hepatitis a outbreak in underserved urban tertiary safety net hospitals. Ann Epidemiol 2021; 64:111-119. [PMID: 34563568 DOI: 10.1016/j.annepidem.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
Outbreaks of Hepatitis A, caused by the Hepatitis A Virus (HAV), remain a worldwide health concern. We conducted a retrospective chart review to characterize patients with acute HAV during an outbreak at our urban tertiary care center to better characterize patients infected with HAV. We searched our electronic records for patients with positive HAV IgM antibodies during a period of outbreak in Philadelphia, May 2017-December 2019. Characteristics of patients were recorded. We searched an equal period of time prior to the outbreak, September 2014-April 2017, to compare the two patient populations. During the outbreak we diagnosed 205 cases of acute HAV compared to just 23 during an equal time period prior to the onset of the outbreak. When compared to the results reported by the public health department for 2019, this accounted for 39.9% of patients documented in the city. A history of drug use was found in 49.4% of our patients while 19.5% of patients were homeless. Our analysis of homelessness and drug usage among documented cases of HAV during the outbreak period mirrored data reported by the city. Further, our analysis found that 7 zip codes accounted for 60% of our patients. Biochemical measures of liver function were higher in patients examined during the outbreak.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Division of Hepatology, Temple University Hospital, Philadelphia, PA; Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
| | - Carolyn Hogan
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Gregory Piech
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Samik Shah
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Tiffany Lambrou
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Marlana Radcliffe
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Amirali Kiani
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Lee Peng
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
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17
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Lin KY, Fang CT. Public Health Responses to Person-to-Person Hepatitis A Outbreaks. J Infect Dis 2021; 223:359-361. [PMID: 33097940 DOI: 10.1093/infdis/jiaa638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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18
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Migueres M, Lhomme S, Izopet J. Hepatitis A: Epidemiology, High-Risk Groups, Prevention and Research on Antiviral Treatment. Viruses 2021; 13:1900. [PMID: 34696330 PMCID: PMC8540458 DOI: 10.3390/v13101900] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/17/2022] Open
Abstract
The hepatitis A virus (HAV) is a leading cause of acute viral hepatitis worldwide. It is transmitted mainly by direct contact with patients who have been infected or by ingesting contaminated water or food. The virus is endemic in low-income countries where sanitary and sociodemographic conditions are poor. Paradoxically, improving sanitary conditions in these countries, which reduces the incidence of HAV infections, can lead to more severe disease in susceptible adults. The populations of developed countries are highly susceptible to HAV, and large outbreaks can occur when the virus is spread by globalization and by increased travel and movement of foodstuffs. Most of these outbreaks occur among high-risk groups: travellers, men who have sex with men, people who use substances, and people facing homelessness. Hepatitis A infections can be prevented by vaccination; safe and effective vaccines have been available for decades. Several countries have successfully introduced universal mass vaccination for children, but high-risk groups in high-income countries remain insufficiently protected. The development of HAV antivirals may be important to control HAV outbreaks in developed countries where a universal vaccination programme is not recommended.
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Affiliation(s)
- Marion Migueres
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Sébastien Lhomme
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jacques Izopet
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
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19
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Ramachandran S, Xia GL, Dimitrova Z, Lin Y, Montgomery M, Augustine R, Kamili S, Khudyakov Y. Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996-2019. Emerg Infect Dis 2021; 27:1742-1745. [PMID: 34013865 PMCID: PMC8153864 DOI: 10.3201/eid2706.203036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hepatitis A virus (HAV) genotype IA was most common among strains tested in US outbreak investigations and surveillance during 1996-2015. However, HAV genotype IB gained prominence during 2016-2019 person-to-person multistate outbreaks. Detection of previously uncommon strains highlights the changing molecular epidemiology of HAV infection in the United States.
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20
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Hofmeister MG, Xing J, Foster MA, Augustine RJ, Burkholder C, Collins J, McBee S, Thomasson ED, Thoroughman D, Weng MK, Spradling PR. Factors Associated With Hepatitis A Mortality During Person-to-Person Outbreaks: A Matched Case-Control Study-United States, 2016-2019. Hepatology 2021; 74:28-40. [PMID: 33217769 PMCID: PMC11017379 DOI: 10.1002/hep.31645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS During 2016-2020, the United States experienced person-to-person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case-fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A. APPROACH AND RESULTS To identify factors associated with hepatitis A-related mortality, we performed a matched case-control study (matched on age [±5 years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak-associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak-associated patients who did not die. There were 110 cases (mean age 53.6 years) and 414 matched controls (mean age 51.9 years); most cases (68.2%) and controls (63.8%) were male. Significantly (P < 0.05) higher odds of mortality were associated with preexisting nonviral liver disease (adjusted odds ratio [aOR], 5.2), history of hepatitis B (aOR, 2.4), diabetes (aOR, 2.2), and cardiovascular disease (aOR, 2.2), as well as initial Model for End-Stage Liver Disease (MELD) score ≥ 30 (aOR, 10.0), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio > 2 (aOR, 10.3), and platelet count < 150,000/μL (aOR, 3.7) among hepatitis A outbreak-associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex). CONCLUSIONS Preexisting liver disease, diabetes, cardiovascular disease, and initial MELD score ≥ 30, AST/ALT ratio ≥ 1, and platelet count < 150,000/μL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the recommendation of the Advisory Committee on Immunization Practices to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered.
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Affiliation(s)
- Megan G. Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Monique A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan J. Augustine
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cole Burkholder
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, MI
| | - Jim Collins
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, MI
| | - Shannon McBee
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV
| | - Erica D. Thomasson
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA
| | - Douglas Thoroughman
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA
- Kentucky Department for Public Health, Frankfort, KY
| | - Mark K. Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip R. Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
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21
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Kang M, Horman SF, Taplitz RA, Clay B, Millen M, Sitapati A, Myers FE, McDonald EC, Abeles SR, Wallace DR, Stous S, Torriani FJ. Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016-2018. Emerg Infect Dis 2021; 26:1374-1381. [PMID: 32568038 PMCID: PMC7323565 DOI: 10.3201/eid2607.191352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During 2016–2018, San Diego County, California, USA, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades. In close partnership with local healthcare systems, San Diego County Public Health led a public health response to the outbreak that focused on a 3-pronged strategy to vaccinate, sanitize, and educate. Healthcare systems administered nearly half of the vaccinations delivered in San Diego County. At University of California San Diego Health, the use of informatics tools assisted with the identification of at-risk populations and with vaccine delivery across outpatient and inpatient settings. In addition, acute care facilities helped prevent further disease transmission by delaying the discharge of patients with hepatitis A who were experiencing homelessness. We assessed the public health roles that acute care hospitals can play during a large community outbreak and the critical nature of ongoing collaboration between hospitals and public health systems in controlling such outbreaks.
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22
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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.
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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
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23
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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.
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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.
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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.
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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
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25
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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.
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Perri M, Dosani N, Hwang SW. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ 2020; 192:E716-E719. [PMID: 32601252 DOI: 10.1503/cmaj.200834] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Naheed Dosani
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
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27
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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.
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"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.
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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.
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Affiliation(s)
- Homie Razavi
- Center for Disease Analysis Foundation, 1120 West South Boulder Road, Suite 102, Lafayette, CO 80026, USA.
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Risk of Hepatitis E among Persons Who Inject Drugs in Hong Kong: A Qualitative and Quantitative Serological Analysis. Microorganisms 2020; 8:microorganisms8050675. [PMID: 32384808 PMCID: PMC7284329 DOI: 10.3390/microorganisms8050675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
Hepatitis E virus (HEV) is an important cause of hepatitis, which can be transmitted via the bloodborne route. However, risk of hepatitis E among persons who inject drugs (PWIDs) is poorly understood. This study aimed to elucidate whether PWIDs are at risk for hepatitis E. We performed HEV IgM, IgG and nucleic acid detection on a cohort of 91 PWIDs and 91 age- and sex-matched organ donors. Blood HEV IgG was measured using the WHO HEV antibody standard. The effects of age, gender and addictive injection use on HEV serostatus and concentration were assessed. HEV IgG seroprevalence was 42/91 (46.2%) in the PWID group and 20/91 (22%) in the donor group (odds ratio = 3.04 (1.59–5.79), p = 0.0006). The median HEV IgG concentration was 5.8 U/mL (IQR: 2.5–7.9) in the PWID group and 2.1 U/mL (IQR: 1.2–5.3) in the donor group (p = 0.005). Increasing age and addictive injection use were significantly associated with HEV IgG serostatus, but only addictive injection use was associated with HEV IgG concentration (p = 0.024). We conclude that PWIDs are at increased risk for hepatitis E and are prone to repeated HEV exposure and reinfection as indicated by higher HEV IgG concentrations.
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