Hepatitis A Outbreak in Michigan Adult Group Homes Suzanne Brunette, BSN, RN Pamela Hackert, MD, JD, MPH
The Beginning Case 1 Group Home A Received referral from MDSS April 24 July 25 Inpatient, elevated liver enzymes, positive IgM Hep A July 10 Info from ICP/Group Home Manager: May 29/30 Non-verbal, developmentally delayed • Admitted from group home 4/16 for • inability to walk; not himself May 21 Sepsis (UTI) • Hospital Course: May 16 Dark urine; yellow sclera in ICU, vent, liver • failure April 24 Passed April 26 • PEP: No work site • 4/29-5/3 Staff and Residents •
The Next Case Case 2 Group Home A Received referral from MDSS May 16 July 25 Inpatient: elevated liver enzymes, positive IgM Hep A July 10 Info from ICP/Group Home Manager: Developmentally delayed, assistance • with toileting May 29/30 Admitted 3x to hospital • 4/23--lethargic for couple of weeks; • Received Hep A vaccine 4/29/13 • May 21 5/6 –lethargic, difficulty walking , chalky • stool; 5/15—dark urine, diarrhea and jaundice; • May 16 Tender abdomen with palpation Hospital Course: 2 weeks inpatient • April 24 PEP: No PEP at vocational center due to good • universal precautions
The 3 rd Case Group Home B Case 3 Received referral from MDSS May 21 July 25 Inpatient: Elevated liver enzymes, IgM Hep A July 10 Info from ICP/Group Home Manager: Brought from group home 5/17 for • May 29/30 painless jaundice Non-verbal, developmentally delayed • Hospital ruled out Hep A May 21 • Hospital Course: 5 days inpatient May 16 • Continue investigation • Specimen sent to MDCH for testing for • confirmation April 24 PEP: No PEP originally but recommended • after state confirmed diagnosis
The Next Two Cases Cases 4 & 5 Group Home B Received report from MDSS May 29 and 30 Inpatient: Elevated liver enzymes, positive IgM July 25 Hep A July 10 Info from ICP/Group Home Manager: Case 4 hospitalized 5/28 for dark urine, • May 29/30 decreased appetite; jaundice Verbal and self-sufficient • Case 5 hospitalized 5/29 for abdominal • May 21 pain, decreased appetite Verbal but developmentally disabled, • May 16 anxiety, acts out Hospital Course: 6 days inpatient; 3 days inpatient • April 24 PEP: Wayne County Health Dept notified for • follow-up of PEP for Case 4’s worksite Clinic for PEP for Case 5’s worksite 6/10 •
The Sixth Case Group Home C Case 6 Received referral from MDSS July 10 July 25 Inpatient: Elevated liver enzymes, positive July 10 IgM Hep A Info from ICP/Group Home Manager: May 29/30 Hospitalized 7/9 for nausea, vomiting • since 7/5, orange urine since 7/7, jaundice at admission May 21 Minimal communication (autistic, • blind, neurologic disorder) May 16 Hospital Course: 5 days inpatient • April 24 PEP: Clients 7/11-7/12; worksite 7/16 •
The Last Case Case 7 Group Home D Received referral from MDSS July 25 July 25 Inpatient: Elevated liver enzymes, positive IgM Hep A July 10 Info from ICP/Group Home Manager: May 29/30 Brought from worksite 7/24 for • jaundice May 21 Attended camp while infectious • Hospital Course: May 16 4 days inpatient • PEP: April 24 Clinic at worksite 7/29 •
Challenges of PEP • Limited window period • Number of contacts for PEP • Consent difficulties • Logistics
Recommendations Adult clients and few staff of Group Homes 2013 ACIP guidelines include Hep A • • have Hep A vaccine prior to exposure vaccine for high risk adults 19 and up Pre-vaccination of Group Home clients/staff Guidelines do not include adults in • • saves time, personnel and money Group Homes as high risk adults
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