hepatitis a outbreak and response in sedgwick county ......hepatitis a outbreak and response in...
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Hepatitis A Outbreak and Response in Sedgwick County, Kansas (2020-2021):A Case Study
Sonalli Kurlekar, MPH
Epidemiologist and Surveillance Coordinator
Sedgwick County Health Department
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March 3, 2021
Overview – Hepatitis A Outbreak
• Introduction – Sedgwick County, Kansas
• Hepatitis A Cases in Kansas
• Outbreak in Sedgwick County
• Outbreak Response Plan and Strategies
• Challenges and Advantages During COVID-19
• Takeaway Message
• Questions?
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Sedgwick County, Kansas
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• 2nd most populous Kansas county- Where Pizza Hut was founded
- Total area of 1,009 square miles
• Urban and rural regions- 18 cities and unincorporated areas
• 2019 Census Data- Population: 514,0000
- Households: 176,444
- Families: 117,688
Hepatitis A Case TrendsKansas, 2015-2020
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Nu
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Outbreak Status
Patients reported one or more risk factors:• 48% IV drug use• 25% Drug use (non-injection)• 17% Homeless or unstable housing issue• 10% Men having sex with men (MSM)• 5% Domestic travel• 5% History of incarceration• 17% Other risk factors• 5% Unknown risk factors
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357 Hepatitis A Cases 83 % Hospitalized 4 Deaths
May 15, 2020 through Feb 26, 2021
Vulnerable Populations in Sedgwick County
6Source: Sedgwick County Drug Misuse Information
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Opioid
Stimulant
Vulnerable Populations in Sedgwick County
• Second largest homeless population in Kansas
• Approximately 800 homeless individuals in 2020
- Three percent increase from 2019
7United Way Plains Report 2019-2020
Outbreak-Epidemiological Curve
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19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 2 3 4 5 6
Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2020 2021
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Calendar Week of Onset Date
Hepatitis A Cases in Hospitals vs. Outpatient in Sedgwick County Residents by Onset Date, from May 2020 -Jan 2021
No. ofHospitalCases
No. ofOutpatientCases
Outbreak Response Plan and Strategies Used by Sedgwick County
Health Department (SCHD)
SCHD TraditionalDisease Investigation and Mitigation
• Hepatitis A is a reportable disease in Kansas
• Epidemiology Program performs disease investigations on patients who test positive for hepatitis A
– Identifying possible risk factors, providing education, and identifying close contacts
• SCHD also provides vaccines to close contacts within 14 days from the last exposure
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A Three-Pronged Strategic Approach to Mitigation
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Vaccination
Sanitation & Hygiene
Education
Education
1. Created Investigation Tools
2. Conducted Virtual/In-person Educational Lectures
3. Created Educational Materials
4. Increased Community Awareness
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Created Investigation Tools
• Extended investigation questionnaire
– For disease investigators
– To identify risk factors and source of infection
• Close contact screening tool
– For emergency room physicians
– To increase close contact vaccination
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Conducted Educational Lectures
• More than 30 virtual and in-person lectures with community partners and high-risk groups
Partner agencies included:
• Hospitals and Healthcare Systems
• Detention Centers
• Homeless Shelters
• Drug Treatment Centers
• Volunteer Medical Service Organizations
• Community Organizations 14
Keys for Educational Outreach:
✓ Identify the high-risk population
✓ Partnering with community organizations who have trusted relationship with underserved populations, works directly with the high-risk population
Created Educational Materials
1. Fact sheet 2. Educational Posters were created for:
2.
These materials were adapted and updated from Seattle - King County Health Department
✓ For MSM
✓ For Homeless People
✓ For All Residents
Sanitation and Hygiene
Created Hygiene Kits and Guide
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Hygiene Kit Hygiene Guide
Vaccination
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SCHD Vaccination Efforts
SCHD Hepatitis A Vaccination
A Nurse Foot Team
>150 Vaccines to Close contacts
Mass Vaccination
Clinics
>250 Vaccines to underserved populations
The best way to prevent hepatitis A infection is through vaccination of at-risk populations
SCHD Strategies to Increase Vaccine Uptake
• Innovative staffing structure
• Call center quick response protocol to handle questions
• Flexible clinic availability
• Flu and hepatitis A combo clinic
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Key for vaccination:✓ Customize community
approaches for vaccine dispensing
✓ Investment in infrastructure for vaccine storage, administration, and tracking procedures
✓ Utilize innovative staffing
Success
390 vaccines used
• Homeless shelters
• Drug treatment centers
• Methadone clinics
• Detention centers
• Close contacts
340 left in stock
• Weekly Vaccination clinic
• More events have been scheduled for the future
Output
Identify high-risk and hard-to-reach population for the vaccination
Increased vaccination
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• Main goal is still elusive…
COVID-19 & Hepatitis A Outbreak Response Challenges
• City and county restrictions affected vaccine uptake
• COVID-19 cases and outbreaks limited vaccination clinics
• Limited in-person contact to hard-to-reach populations
• Limited staffing capacity and resources 22
COVID-19 & Hepatitis A Outbreak Response Advantages
• Pre-established relationships with community partners who work with vulnerable populations
• Existing contracts with temporary staffing agencies
• COVID-19 funding supported sanitation and hygiene kits
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Key Takeaways
• Multidimensional approach for hepatitis A response
• Adapted to existing resources
• Customized approach to design response plan for your community.
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Acknowledgements
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Sedgwick County Health Department’s Epidemiology Program:
Christine Steward, MPH Kaylee Hervey, MPHVance Atha, BS Erica Graham, BA
Amy Floyd, RN
Sedgwick County Health Department’s Immunization Program:
Van Tran, RNCarrie Briscoe
Kansas Department of Health and Environment:Sarah Chicchelly-MPH
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Thank You!