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Use of Molecular Epidemiology to Inform Response to a Hepatitis A Outbreak - Los Angeles County, California, October 2018-April 2019.
MMWR Morb Mortal Wkly Rep. 2020 Jul 03; 69(26):820-824.MM

Abstract

Los Angeles County comprises 4,058 square miles and is home to approximately 10 million residents (1), an estimated 59,000 (0.6%) of whom experience homelessness on a given night (2). In late 2018, Los Angeles County Department of Public Health (LAC DPH) was notified of a case of hepatitis A virus (HAV) infection in a person experiencing homelessness. LAC DPH conducted an investigation to determine the source of infection, identify additional cases, and identify contacts for postexposure prophylaxis (PEP). Over the next week, LAC DPH identified two additional hepatitis A cases in persons experiencing homelessness who knew one another socially and were known to congregate at a specific street intersection. To identify and respond rapidly to additional outbreak-associated cases, LAC DPH implemented enhanced surveillance procedures, including immediately obtaining specimens for molecular testing from all patients with suspected hepatitis A in the same geographic area. Enhanced surveillance identified four additional cases in persons linked to a senior living campus within two blocks of the intersection where the initial three patients reported congregating. These four cases were linked to the cluster in persons experiencing homelessness through HAV genotyping. Overall, DPH identified seven outbreak-associated hepatitis A cases during October 2018-January 2019. The DPH response to this community hepatitis A outbreak included conducting vaccination outreach to persons at risk, conducting environmental health outreach to restaurants in the outbreak area, and issuing health care provider alerts about the increased occurrence of hepatitis A. Implementation of near real-time molecular testing can improve hepatitis A outbreak responses by confirming HAV infections, linking additional cases to the outbreak, and informing the targeting of prevention efforts.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32614812

Citation

Haddix, Meredith, et al. "Use of Molecular Epidemiology to Inform Response to a Hepatitis a Outbreak - Los Angeles County, California, October 2018-April 2019." MMWR. Morbidity and Mortality Weekly Report, vol. 69, no. 26, 2020, pp. 820-824.
Haddix M, Civen R, Hacker JK, et al. Use of Molecular Epidemiology to Inform Response to a Hepatitis A Outbreak - Los Angeles County, California, October 2018-April 2019. MMWR Morb Mortal Wkly Rep. 2020;69(26):820-824.
Haddix, M., Civen, R., Hacker, J. K., Probert, W., New, S., Green, N., Hemarajata, P., & Gounder, P. (2020). Use of Molecular Epidemiology to Inform Response to a Hepatitis A Outbreak - Los Angeles County, California, October 2018-April 2019. MMWR. Morbidity and Mortality Weekly Report, 69(26), 820-824. https://doi.org/10.15585/mmwr.mm6926a3
Haddix M, et al. Use of Molecular Epidemiology to Inform Response to a Hepatitis a Outbreak - Los Angeles County, California, October 2018-April 2019. MMWR Morb Mortal Wkly Rep. 2020 Jul 3;69(26):820-824. PubMed PMID: 32614812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Molecular Epidemiology to Inform Response to a Hepatitis A Outbreak - Los Angeles County, California, October 2018-April 2019. AU - Haddix,Meredith, AU - Civen,Rachel, AU - Hacker,Jill K, AU - Probert,Will, AU - New,Sarah, AU - Green,Nicole, AU - Hemarajata,Peera, AU - Gounder,Prabhu, Y1 - 2020/07/03/ PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/7/medline SP - 820 EP - 824 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb. Mortal. Wkly. Rep. VL - 69 IS - 26 N2 - Los Angeles County comprises 4,058 square miles and is home to approximately 10 million residents (1), an estimated 59,000 (0.6%) of whom experience homelessness on a given night (2). In late 2018, Los Angeles County Department of Public Health (LAC DPH) was notified of a case of hepatitis A virus (HAV) infection in a person experiencing homelessness. LAC DPH conducted an investigation to determine the source of infection, identify additional cases, and identify contacts for postexposure prophylaxis (PEP). Over the next week, LAC DPH identified two additional hepatitis A cases in persons experiencing homelessness who knew one another socially and were known to congregate at a specific street intersection. To identify and respond rapidly to additional outbreak-associated cases, LAC DPH implemented enhanced surveillance procedures, including immediately obtaining specimens for molecular testing from all patients with suspected hepatitis A in the same geographic area. Enhanced surveillance identified four additional cases in persons linked to a senior living campus within two blocks of the intersection where the initial three patients reported congregating. These four cases were linked to the cluster in persons experiencing homelessness through HAV genotyping. Overall, DPH identified seven outbreak-associated hepatitis A cases during October 2018-January 2019. The DPH response to this community hepatitis A outbreak included conducting vaccination outreach to persons at risk, conducting environmental health outreach to restaurants in the outbreak area, and issuing health care provider alerts about the increased occurrence of hepatitis A. Implementation of near real-time molecular testing can improve hepatitis A outbreak responses by confirming HAV infections, linking additional cases to the outbreak, and informing the targeting of prevention efforts. SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/32614812/Use_of_Molecular_Epidemiology_to_Inform_Response_to_a_Hepatitis_A_Outbreak_-_Los_Angeles_County,_California,_October_2018-April_2019 L2 - https://doi.org/10.15585/mmwr.mm6926a3 DB - PRIME DP - Unbound Medicine ER -