An Explosive Outbreak

BY JEFF SIMMONS

How are health officials addressing a liver disease that has become an astounding 19 times more common in just a few short years?

THE NUMBERS ARE STAGGERING. FOUR YEARS AGO, 1,390 CASES OF hepatitis A were reported across the United States. But since 2016, 30 states have now reported some 26,276 outbreaks (with 60% of those infected requiring hospitalization) and 268 deaths - mostly among atrisk groups including drug users and men who have sex with men. In some regions, the volume of cases has been so extreme that officials have declared public health emergencies. The outbreak is prompting health officials to ramp up education and outreach efforts. That includes enlisting support from community-based organizations and even smartphone apps to cast as wide an awareness net as possible.

UNDERSTANDING THE OUTBREAK

“From our standpoint, as the outbreaks continue, it’s critical to make sure that populations that are vulnerable to infection – people who use drugs or are transient, gay and bisexual men – are vaccinated,” says Dr. Monique Foster, medical officer at the Center for Disease Control’s Division of Viral Hepatitis. “We’ve all been working together to alert all states, those having cases and not having cases, to both prevent and respond to outbreaks.”

Hepatitis A is an incredibly contagious liver infection that is carried by a virus found in the stools of infected people. It is most commonly spread from person to person, often through close personal contact and sex with a carrier. People who get the virus sometimes feel sick for a few weeks to several months. While most people recover and do not have lasting liver damage, some become so ill that they must be hospitalized until their conditions stabilize.

Foster says people with chronic liver disease are at higher risk for complications. Healthcare experts also recently advised those with HIV or AIDS to get vaccinated as well. “Individuals living with HIV and AIDS can suffer higher morbidity and mortality rates if they are infected with the virus,” she asserts. The hepatitis A vaccine is the best way to prevent infection. One dose of single-antigen vaccine provides up to 95% seroprotection in healthy individuals for up to 11 years.

HOW WE FIGHT IT

Outbreaks are spreading across the country, with the steepest numbers in regions also coping with other public health challenges — like opioids. Tennessee, Ohio, and West Virginia and Florida have tallied the most incidents so far – more than 3,000 - with 40 deaths resulting. In encouraging news, two states – California and Utah – have already declared an end to their outbreaks.

Working with health officials, the mobile app Grindr has been alerting users about the outbreak, echoing earlier warnings about meningitis. In October 2018, the Illinois Department of Health approached Grindr about the increase in hepatitis A cases. So the social app began issuing weekly hepatitis A advisories. The alerts later expanded to reach users in other regions across the country.

“We have reached more than three million unique Grindr users with these alerts in five states, four cities and one country outside of the United States,” said Grindr’s Global Health Projects Manager, Emmett Patterson. “We don’t only want to work with health departments,” he says, “but with community-based organizations, too.”

His colleague,director of Grindr for Equality Jack Harrison adds, “We are always thinking about how we can build new features into the app to help people manage their health.” Similarly, Grindr also regularly notifies users about the importance of HIV testing and introduced features that allow users to set up reminders to be tested.

Patterson concludes, “We do have the opportunity to reach people to help them take control of their bodies and their health.”