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WSU Medical School
Wayne State University
Introduction: Hepatitis A (HAV) is a self-limiting viral liver disease that can manifest as abdominal pain, anorexia, nausea, fatigue, and jaundice with elevated serum aminotransferase levels. Despite an efficacious vaccine, there has been an outbreak across the country, including metropolitan Detroit. Recent cases in Michigan have presented with severe life-threatening manifestations. Already, 905 cases of hepatitis A have been reported in Michigan in the months of September and October 2018, of which 726 have resulted in hospitalization (80.2%) and 28 deaths. The historical notion of transmission fecal-orally via food is now more complex, as higher risk populations include those using drugs and those experiencing homelessness. This study evaluated risk factors for hepatitis A in an epidemic setting in urban Detroit including potential association with Detroit mandated water shutoff.Methods: Patients who received care at Henry Ford Health System between August 2016 and December 2017 with positive hepatitis A diagnoses were selected if their electronic medical record (EMR) indicated their home addresses within Detroit city proper. Patients were contacted via telephone numbers listed in the EMR and asked for voluntary phone interview participation. Patients were asked a standardized set of questions. This study was approved by the Henry Ford Hospital Institutional Review Board.Results: Sixty-six Detroit patients with Hepatitis A were reviewed. Twenty-two were available for contact and agreed to phone interview. Thirteen of the 22 were male (59.1%). Average age was 49, ranging from 21 to 81 years of age. Three (13.6%) had a history of intravenous drug use; two (9.1%) were food handlers; and four (14.2%) were homeless. Three patients (13.6%) were discovered deceased upon phone interview with a family member and fourteen (63.6%) were hospitalized, according to hospital records. Of note, four patients (14.2%) had their water shut off. Conclusion: Recent data from the CDC demonstrates a new trend of hepatitis A infections among persons reporting injection or non-injection drug use or homelessness. This study evaluated risk factors for hepatitis A in an epidemic setting in urban Detroit including potential association with Detroit-mandated water shutoffs. It is worth investigating the importance of water shutoffs and homelessness among hepatitis A outbreaks, as those who are homeless often lack access to clean water. This public health crisis continues despite a HAV vaccine being readily available and efficacious, warranting further investigation as to the source.
Hsia, Tammy and Zervos, Marcus J., "Investigating Detroit Water Shutoffs and Hepatitis A" (2019). Clinical Research. 61.