Hepatitis A Outbreak in Michigan Adult Group Homes Suzanne - - PowerPoint PPT Presentation

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 Inpatient, elevated liver enzymes, positive IgM Hep A Info from ICP/Group Home Manager:

• Non-verbal, developmentally delayed
• Admitted from group home 4/16 for

inability to walk; not himself

• Sepsis (UTI)

Hospital Course:

• Dark urine; yellow sclera in ICU, vent, liver

failure

• Passed April 26

PEP:

• No work site
• 4/29-5/3 Staff and Residents

July 25 July 10 May 29/30 May 21 May 16

April 24

The Next Case

Case 2 Group Home A

Received referral from MDSS May 16 Inpatient: elevated liver enzymes, positive IgM Hep A Info from ICP/Group Home Manager:

• Developmentally delayed, assistance

with toileting

• Admitted 3x to hospital
• 4/23--lethargic for couple of weeks;
• Received Hep A vaccine 4/29/13
• 5/6 –lethargic, difficulty walking , chalky

stool;

• 5/15—dark urine, diarrhea and jaundice;

Tender abdomen with palpation

Hospital Course:

• 2 weeks inpatient

PEP:

• No PEP at vocational center due to good

universal precautions

July 25 July 10 May 29/30 May 21

May 16

April 24

The 3rd Case

Case 3 Group Home B

Received referral from MDSS May 21 Inpatient: Elevated liver enzymes, IgM Hep A Info from ICP/Group Home Manager:

• Brought from group home 5/17 for

painless jaundice

• Non-verbal, developmentally delayed
• Hospital ruled out Hep A

Hospital Course:

• 5 days inpatient
• Continue investigation
• Specimen sent to MDCH for testing for

confirmation

PEP:

• No PEP originally but recommended

after state confirmed diagnosis

July 25 July 10 May 29/30

May 21

May 16

April 24

The Next Two Cases

Cases 4 & 5 Group Home B

Received report from MDSS May 29 and 30 Inpatient: Elevated liver enzymes, positive IgM Hep A Info from ICP/Group Home Manager:

• Case 4 hospitalized 5/28 for dark urine,

decreased appetite; jaundice

• Verbal and self-sufficient
• Case 5 hospitalized 5/29 for abdominal

pain, decreased appetite

• Verbal but developmentally disabled,

anxiety, acts out Hospital Course:

• 6 days inpatient; 3 days inpatient

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

July 25 July 10

May 29/30

May 21 May 16

April 24

The Sixth Case

Case 6 Group Home C

Received referral from MDSS July 10 Inpatient: Elevated liver enzymes, positive IgM Hep A Info from ICP/Group Home Manager:

• Hospitalized 7/9 for nausea, vomiting

since 7/5, orange urine since 7/7, jaundice at admission

• Minimal communication (autistic,

blind, neurologic disorder) Hospital Course:

• 5 days inpatient

PEP:

• Clients 7/11-7/12; worksite 7/16

July 25

July 10

May 29/30 May 21 May 16

April 24

The Last Case

Case 7 Group Home D

Received referral from MDSS July 25 Inpatient: Elevated liver enzymes, positive IgM Hep A Info from ICP/Group Home Manager:

• Brought from worksite 7/24 for

jaundice

• Attended camp while infectious

Hospital Course:

• 4 days inpatient

PEP:

• Clinic at worksite 7/29

July 25

July 10 May 29/30 May 21 May 16

April 24

Challenges of PEP

• Limited window period
• Number of contacts for PEP
• Consent difficulties
• Logistics

Recommendations

• 2013 ACIP guidelines include Hep A

vaccine for high risk adults 19 and up

• Guidelines do not include adults in

Group Homes as high risk adults

• Adult clients and few staff of Group Homes

have Hep A vaccine prior to exposure

• Pre-vaccination of Group Home clients/staff

saves time, personnel and money