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Alert Date: 
Tuesday, January 30, 2018 - 9:00am
Location: 
Michigan

The Windsor-Essex County Health Unit is closely following reports of Hepatitis A outbreaks in Michigan.  While there have been no cases related to these outbreaks in Windsor-Essex, our community’s proximity to the border and the daily movement across mean that there is a possibility of exposure for our population. 

As well, Public Health Ontario, in collaboration with local, provincial, and federal public health authorities, is investigating a province wide increase in the incidence of hepatitis A. The increase has been linked to outbreaks occurring in the United Kingdom and Europe as well as an overall increase in the incidence of locally acquired cases and non-travel related cases especially among men who have sex with men (MSM)

Vaccination is the most effective way to prevent and protect people from Hepatitis A and there are a number of options available to our community.  It is our intention to make you aware of these options, as well as particular groups for whom vaccination is publically funded, and encourage you to discuss vaccination with your patients where appropriate. 

Hepatitis A Vaccinations:

There are two options for vaccination against Hepatitis A. 

Havrix is used to protect against Hepatitis A alone.  One dose provides immunity for up to one year.  A second dose given 6 to 12 months after the first provides 10 or more years of protection.  This vaccine is used for both pre-exposure protection (i.e. for travelers or those requesting immunization), as well as for post-exposure prophylaxis.  The Health Unit follows up directly with hepatitis A contacts for post- exposure prophylaxis (PEP) vaccination. The Health Unit will contact clinicians if your patient is deemed a contact and will provide vaccine as required. 

Twinrix is a combination vaccine against both Hepatitis A and B and is a series of three injections.  The first and second doses need to be given at an interval of at least one month, and provide immunity for up to one year.  A third dose given five months or longer after the second dose provides 10 or more years of protection. 

Vaccination with Havrix is publically funded for high risk individuals.  The eligibility criteria for Hepatitis A Vaccine (2 doses) is as follows:

  • Individuals with chronic liver disease (including hepatitis B and C)
  • Individuals who use injection drugs
  • Men who have sex with men (MSM)

We recommend vaccination for those at high risk as well as travelers, health care providers, food handlers or those who are immunocompromised.

Diagnosis and Management of Hepatitis A Cases:

The Provincial Case Definition for hepatitis A outlines the laboratory evidence required and the serology approved. 

Lab Evidence:

For suspected cases or contacts of hepatitis A, please ensure blood is submitted for serology for diagnostics. Serology approved validated tests for hepatitis A include; Anti-HAV IgM and Anti- HAV total (IgG and IgM) antibody. Ontario Public Health Laboratory is available for consultation on laboratory testing with health care providers as needed at (toll free) 1-877-604-4567.

Clinical Evidence:

Acute clinical illness is characterized by abrupt fever, malaise, anorexia, nausea and abdominal pain followed by jaundice or elevated aminotransferase levels within a few days. Please ensure to capture the date of symptom onset, including date of onset of jaundice for suspected cases.

All clinically diagnosed, probable and confirmed cases must be reported to the Health Unit immediately @ 519-258-2146 ext. 1420 from 08:30- 4:30 or after hours @ 519-973-4510. The OHIP code for payment for personally reporting all reportable diseases of immediate concern is K034A.

Our website (www.wechu.org) is a reference for health care providers and patients. For additional information or consultation, please call the Health Unit during regular office hours at 519-258-246 ext. 1420. During after hours and weekends, please call 519-973-4510.

For more information, visit: