Cristian Rodriguez (ID: 3032172742)
Hepatitis A Virus Analysis
Hepatitis A Virus is a non-enveloped, single-stranded RNA virus1 of the Picarnoviridae family2 that causes infectious disease with symptoms such as “fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice”.3 There is no animal reservoir.4 HAV is simply transmitted among humans and it is specifically done so through primarily fecal-oral means. Forms of transmission involve contaminated food and water, usage of unclean needles, poor hygiene and sanitation, and sexual intercourse. Certain forms of transmission can be more common in developed nations while not so common in other nations and vice versa. For instance, in developed nations, transmission typically occurs among adults such as for drug users and the sexually active. This would be the case for developing nations, but in developing nations, especially those under quite poor economic circumstances, poor hygiene and sanitation leads to transmission typically among children who then mature to become immune.5 Treatment is typically self-care of rest and rehydration.6, 7, 8 As for preventative measures, there is vaccination. In the United States, licensed inactivated vaccines include two single-antigen vaccines, HAVRIX® and VAQTA®, as well as a combination vaccine, TWINRIX®.9
The 2017 California HAV outbreak is the second largest U.S. outbreak in the past 20 years.10 A state of emergency has even been declared by Governor Brown.11 As of October 27, 2017, the 2017 California HAV outbreak has led to a total of 633 cases and 21 deaths with 536 of these cases and all but one of these deaths being in the San Diego jurisdiction. The populations affected so far have largely been the homeless and/or illicit drug users, which has posed further challenges give that such groups may hold distrust against authorities or suffer from mental illness. Also common among such groups is alcohol-induced liver damage, which can lead to further complications and possibly death.12 Those also at risk are travelers, those living in crowded households, men who have sex with men, and illicit drug users. Various measures are currently being undertaken for the affected. Those not immunized among the populations greatly affected so far or at risk for infection are being provided vaccination as well as those who interact with such groups.13 In addition, hand washing stations and public toilets are being provided especially since such resources aren’t as easily accessible for the homeless as needed.12 San Diego has also initiated power washing of streets in the downtown areas with bleach.14
Still, I propose further measures need to be taken in order to contain the outbreak, reduce transmission, and prevent future outbreaks. Firstly, while the living conditions and poor sanitation among homeless encampments are being addressed, injection drug users are not being aided as closely. Bleach kits for syringe disinfection should be granted to injection drug users (IDUs).15 In addition, IDUs should be encouraged to receive sterilized syringes, if needed, from syringe service programs (SSPs).16 In order to further contain the outbreak, vaccination programs should not only be targeting the homeless and IDUs, but also food service workers and those with risk factors in the San Diego jurisdiction. However, for prevention of future U.S. outbreaks, routine vaccination of all U.S. food service workers would be unnecessary.17 Rather, the vaccination of adolescents among the states of highest HAV disease rates would be adequate specifically given its cost-effective nature. Financially, vaccination programs would be the bear the greatest financial burden of my plan detailed. One birth cohort would require $30.9 million for vaccination. However, decline in work loss and other costs would offset this.18 Lastly, it cannot be ignored that installment of public restrooms and hand washing stations for the homeless could also be implemented. Ultimately, I propose a plan of action that targets drug users refusing to end drug usage to practice syringe disinfection and sterilization, vaccination programs for those with risk factors or in adolescence, and installation of public restrooms for homeless communities.
“Hepatovirus.” Viralzone, ExPASy, viralzone.expasy.org/94?outline.
“Taxonomy.” International Committee on Taxonomy of Viruses (ICTV), talk.ictvonline.org/taxonomy/.
3. “Hepatitis A.” World Health Organization, World Health Organization, www.who.int/mediacentre/factsheets/fs328/en/.
4. “Hepatitis A.” WHO, World Health Organization, www.who.int/ith/diseases/hepatitisA/en/.
5. Franco, Elisabetta et al. “Hepatitis A: Epidemiology and Prevention in Developing Countries.” World Journal of Hepatology 4.3 (2012): 68–73. PMC. Web. 4 Nov. 2017.
6. Gilroy, Richard K. “Hepatitis A Treatment & Management.” Hepatitis A Treatment & Management: Approach Considerations, Supportive Care, Liver Transplantation, 16 Oct. 2017, emedicine.medscape.com/article/177484-treatment?pa=ydzxGh52EcbezpxPUeSPyY1esvcax%2B3lD13cEpaVVU0H4UFFGpPZd6Q%2BD0P82yFHjaX8QdmbNSkHRzJ0EyR2CiRhZLc6xjdjmi9FlNdSZuc%3D.
7. “Hepatitis A.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Oct. 2017, www.mayoclinic.org/diseases-conditions/hepatitis-a/diagnosis-treatment/drc-20367055.
8. “Treatment for Hepatitis A Infection.” Treatment for Acute Hepatitis A Infection | Hepatitis A Food Poisoning, www.about-hepatitis.com/hepatitis_treatment#.WfvnlLaZNE4.
9. “Viral Hepatitis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Oct. 2017, www.cdc.gov/hepatitis/hav/havfaq.htm#vaccine.
10. Karlamangla, Soumya. “California's Deadly Hepatitis A Outbreak Could Last Years, Official Says.” Los Angeles Times, Los Angeles Times, 5 Oct. 2017, www.latimes.com/local/california/la-me-ln-hepatitis-outbreaks-20171006-htmlstory.html.
11. GOVERNOR BROWN DECLARES STATE OF EMERGENCY TO INCREASE SUPPLY OF HEPATITIS A VACCINES. State of California, 13 Oct. 2017, www.gov.ca.gov/news.php?id.
12. “Hepatitis A Outbreak.” Division of Communicable Disease Control, 2 Nov. 2017, www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Hepatitis-A-Outbreak.aspx.
13. “Viral Hepatitis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Oct. 2017, www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm.
14. News, Stephanie O'Neill Kaiser Health. “California Scrambles to Contain Deadly Hepatitis A Outbreaks.” The Mercury News, The Mercury News, 2 Oct. 2017, www.mercurynews.com/2017/10/02/california-scrambles-to-contain-deadly-hepatitis-a-outbreaks/.
15. POLICY BRIEF: PROVISION OF STERILE INJECTING EQUIPMENT TO REDUCE HIV TRANSMISSION. World Health Organization, Mar. 2004, apps.who.int/iris/bitstream/10665/68711/1/WHO_HIV_2004.03.pdf.
16. “HIV/AIDS.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Sept. 2017, www.cdc.gov/hiv/risk/ssps.html.
17. David Acheson, Anthony E. Fiore; Hepatitis A Transmitted by Food, Clinical Infectious Diseases, Volume 38, Issue 5, 1 March 2004, Pages 705–715, https://doi.org/10.1086/381671
18. Jacobs, MPA R. Jake. “The Cost-Effectiveness of Adolescent Hepatitis A Vaccination in States With the Highest Disease Rates.” Archives of Pediatrics & Adolescent Medicine, American Medical Association, 1 Aug. 2000, jamanetwork.com/journals/jamapediatrics/fullarticle/350473.
Note: Citations 5 and 18 are derived from PubMed. Citation 5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321492/ and Citation 18: https://www.ncbi.nlm.nih.gov/pubmed/10922271
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