Information regarding hepatitis A outbreak in Southeast Michigan

October 6, 2017  //  FOUND IN: Updates & Resources

Washtenaw County Public Health has confirmed a positive case of hepatitis A virus (HAV) infection in a worker from Cardamom Restaurant in Ann Arbor located at 1739 Plymouth Road in Ann Arbor. Potential exposure could have occurred between Sept. 16 and Oct. 3.

Post-exposure prophylaxis (PEP): Anyone who has consumed food and/or drink at Cardamom since Friday, Sept. 22 should have their immune status to HAV assessed. If not immune (two doses of vaccine or history of disease), individuals should seek the hepatitis A vaccine or immune globulin (IG).

The recommended PEP within 14 days of exposure is:

  • Hepatitis A vaccine: For healthy persons aged 12 months through 40 years.
  • Immune globulin (IG):
    • Persons 41 years and older. IG is preferred but HAV vaccine can be used if IG is not available. Priority for IG should be given to non-immunized pregnant women and those >70 years of age.
    • Children younger than 12 months of age.
    • Immunocompromised persons.

Anyone who has consumed food and/or drink at Cardamom since Saturday, Sept. 16 should monitor for symptoms of HAV including fatigue, poor appetite, stomach pain or tenderness, nausea or vomiting, dark urine, and jaundice. Symptoms typically appear two to six weeks after exposure. Individuals with symptoms should follow up with their primary care provider.

Please be advised that Michigan Medicine workforce members who may have been exposed can receive a vaccine from Occupational Health Services, but will need to follow up with their primary care provider if immune globulin is required.

For patients showing signs of symptoms, the following lab tests are recommended: 

  • Acute hepatitis serology (including Hepatitis A IgM)
  • Liver enzymes are also helpful

HAV may spread through ingestion of food or water or through oral contact with objects (including hands) contaminated by feces of an HAV-infected individual. Some individuals, especially if co-infected with hepatitis B or C, may develop fulminant liver failure resulting in death.

The Michigan Department of Health and Human Services reports that transmission in this outbreak appears to be related to direct person to person spread and illicit drug use. There have not been common food or water sources identified.

More information related to the outbreak may be found by clicking here.

Infection Control practices in healthcare settings with acute HAV cases:

  • Use standard precautions during all patient care activities. Use gloves when having direct contact with feces or contaminated materials.
  • Contact Precautions-D should be used in the inpatient setting for patients with confirmed or suspected HAV infection.
  • Wash hands with soap and running water for at least 15 seconds after providing care for an individual with HAV.  Alcohol-based hand rubs may not be effective against HAV.
  • Use bleach or other hospital approved disinfectants that are effective against norovirus to clean the environment or equipment.
  • Hepatitis A vaccination is encouraged for unvaccinated healthcare workers with chronic liver disease who may care for patients with HAV infection and others who are concerned about risk of HAV infection.
  • Health care workers that care for patients with HAV infection are encouraged to be vaccinated for HAV.
    • Vaccine is available via Occupational Health Services Monday-Friday, 7 a.m. – 4:30 p.m.
    • Please contact occupational health at OccupationalHealth-RN@med.umich.edu if you have questions about vaccination for Michigan Medicine employees.

Please notify the Department of Infection Prevention & Epidemiology if you identify a patient with suspected or confirmed HAV at 936-6355 or page 30032.

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