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

Sonali.kurlekar@Sedgwick.gov

1

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?

2

Sedgwick County, Kansas

3

• 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

4

Nu

mb

er

of

He

pat

itis

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

5

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

0

10

20

30

40

50

60

70

Nu

mb

er

of

ER V

isit

s

Months

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

8

0

2

4

6

8

10

12

14

16

18

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

No

. of

He

pat

itis

A C

ase

s

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

10

A Three-Pronged Strategic Approach to Mitigation

11

Vaccination

Sanitation & Hygiene

Education

Education

1. Created Investigation Tools

2. Conducted Virtual/In-person Educational Lectures

3. Created Educational Materials

4. Increased Community Awareness

12

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

13

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

17

Hygiene Kit Hygiene Guide

Vaccination

19

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

20

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

21

• 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

23

Key Takeaways

• Multidimensional approach for hepatitis A response

• Adapted to existing resources

• Customized approach to design response plan for your community.

24

Acknowledgements

25

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

26

Thank You!