XPost: mi.misc, alt.society.liberalism, soc.culture.african.american
XPost: sac.politics

Obviously Democrats are filthy people who engage in eating fecal
matter.

An alarming number of hepatitis A cases have swept across
southeast Michigan since August 2016 in what public health
officials said is one of the largest outbreaks to occur in the
United States since a vaccine was widely introduced two decades
ago.

In 2017 alone, Michigan has led the nation in hepatitis cases
per capita, according to a Free Press analysis. More than 500
cases have been reported this year.

The far-reaching outbreak — which has heavily impacted Wayne,
Macomb and Oakland counties — has created a coalition of sorts
among local and state officials who are working to keep the
disease from spreading among the region’s most vulnerable, at
risk populations. Detroit and Macomb County have the highest
rate of outbreak related cases at about 2 cases per 10,000
residents.

The cause of the outbreak is not yet known but officials say
they're probing a link to the ongoing opioid and heroin crisis
seen across Michigan, as well as other potential exposure routes.


"We're continuing to see new cases almost every day so it is a
concern," said Macomb County Health Department Director Bill
Ridella. "I think there is a strong connection to a number of
these cases with the opioid and heroin problem. About half of
the cases in Macomb County has some connection with drug use
and/or heroin."

But state officials said since other exposure routes have been
found, it hasn't been easy to discern the exact origin.

"Typically what we would see this time of year is about 14 times
lower than what we’re currently dealing with," said Angela
Minicuci, Michigan Department of Health and Human Services
spokesperson. "I don’t know if we’ve seen a hepatitis A outbreak
like this before."

To put the outbreak in perspective, Wayne County's Department of
Health, Veterans & Community Wellness Medical Director Ruta
Sharangpani said only two to three cases are typically seen in a
given year within the county.

And a shortage of vaccinations across the country has also
created an uphill battle for public health officials. The
Centers for Disease Control is exploring options to increase
vaccine supply, and one manufacturer has said it might be able
to supply more to support the demand. Since hepatitis A is a vaccine-preventable illness, officials are urging people to
speak with their medical providers to determine if they should
obtain it.

"The demand for adult hepatitis A vaccine(s) has increased
substantially over the past six months and vaccine supply to
meet this unexpected demand in the U.S. has become constrained,"
the CDC said in a statement to the Free Press. "While CDC and
state/local public health officials are targeting vaccine to
manage outbreaks and carry on routine vaccination, current
supply is not sufficient to support demand for vaccine."

20 deaths reported in Michigan
Hepatitis A is a serious, highly contagious liver disease caused
by the hepatitis A virus, according to the CDC. HAV is found in
the feces of people with hepatitis A and can be spread by eating
contaminated food or water or during sex. The risk also
increases by living with someone who has been infected.

Illness can appear 15-50 days after exposure and an individual
can be sick for several weeks. Symptoms include nausea and
vomiting, abdominal pain, yellowing of the skin and eyes.

Statewide, there have been 20 deaths associated with the current
hepatitis A outbreak which began Aug. 1, 2016.

Eight of those deaths were Detroit residents who had a case of
hepatitis A when they died.

Detroit Health Department Director Dr. Joneigh Khaldun said
while she can’t share specific information about the eight
reported deaths due to privacy laws, she said some of the
individuals may have had other underlying illnesses that
ultimately led to their deaths.

“Someone who died might have had hepatitis A and it’s not
necessarily the reason for their actual death,” Khaldun said.
“To pick apart every single death that had an association with
hepatitis A, I think that is not the real point here. The most
important point is we want to make sure we’re protecting our
citizens. We want to make sure we’re getting ahead of it and
vaccinating. We want to make sure that our clinicians are being
very vigilant and looking for people who might have symptoms so
we can get ahead of this outbreak. That’s the most important
thing to talk about.”

Three deaths also each occurred in Macomb, Oakland and Wayne
counties (not including Detroit) -- for a total of 9 additional
deaths associated with the outbreak. While one death associated
with hepatitis A happened in Ingham, Livingston and Monroe
counties.


Minicuci says there's usually about a one-year lag from the date
of death to when the state compiles and releases information on
the number of deaths caused by hepatitis A.

Yet, in an e-mail to the Free Press she shared that death
certificates are available for 18 of the 20 deaths and "six of
the 18 specifically list hepatitis A." Three list a cause of
death related to liver failure or liver disease and nine died
while hospitalized with hepatitis A or within 30 days of
discharge.

People who have died from the disease tend to be older with a
median of 58 years old, according to an analysis by the state.

There are usually very few deaths caused solely by hepatitis A.

Between 2011 and 2016 there were four deaths determined to be
caused by hepatitis A in the state, three deaths in 2013 and one
in 2016, according to vital statistics data.

But Minicuci said Michigan isn’t the only state experiencing an
outbreak of some nature.

“It’s certainly something that we’re treating as a very unique
situation here in Michigan but so are a lot of other states
nationally,” Minicuci said.

In Michigan, in 2017 alone, the state had 527 cases, which is a
rate of 5.3 per 100,000 residents. Other states being monitored
by the CDC during the current outbreak include: Utah with 101
cases this year- a rate of 3.3 per 100,000 residents; California
with 666 cases, or 1.7 cases per 100,000 residents; and Kentucky
with 31 cases -- a rate of 0.7 cases per 100,000 residents.
California has reported 21 deaths since the outbreak began.

In 2015, the latest nationwide data available, there were 1,390
hepatitis A cases - a rate of 0.4 cases per 100,000 people,
according to the CDC.

The CDC stated in an e-mail that Michigan's outbreak is
unrelated to the one in California but similar in terms of the
affected population - mainly homeless people and people who
report drug use. According to the CDC, an outbreak in San Diego
led to outbreaks of hepatitis A in other California cities,
Arizona and Utah.

“The outbreak is caused by related strains of the same
hepatitis A virus genotype (IB),” the CDC said in a statement to
the Free Press. “These strains are not commonly seen in the
United States, but are common in other parts of the world. …
While what is occurring in Michigan and San Diego, a large
community wide outbreak, has not happened in the last 25 years
(since the widespread use of vaccine), outbreaks of this nature
have occurred historically.”

Just under half, 48%, of cases in Michigan are related to drug
use and a majority of cases are men -- 65%. About 12% of
individuals with the disease are homeless.

Macomb County District Judge Linda Davis, president of the
grassroots organization Families Against Narcotics (FAN), said
she's not surprised by a potential link to the opioid and
addiction crisis.

"There's going to be lots of consequences (of the crisis,)"
Davis said. "It's not just hepatitis A, it's AIDS, it's
hepatitis A, B and C, they are all aftermaths of addiction. A
large number of the people in drug courts and that we just deal
with generally through FAN have hepatitis A and have been
treated for it or awaiting treatment for it. The numbers are
large."

Among hepatitis A outbreak cases, about 1 in 3 cases, 31%, have
a history of hepatitis B or C.

Hepatitis and the food industry
Many in the public learn of hepatitis cases only when someone
who works in the food service industry is diagnosed with having
it. Since August of last year, local health departments have
sent out regular releases, alerting the public to new cases at
restaurants across the tri-county area.

At the end of November, the Detroit health department announced
a Greektown Casino employee had been diagnosed with hepatitis A.
The announcement came just two days after it announced a
separate case at a McDonald's on West Grand Boulevard.

And just last week, Oakland County announced an employee at a
Papa Romano's in Southfield had been diagnosed with hepatitis A.
Oakland County announced last week that it plans to hold two
clinics aimed at vaccinating food service workers.

As the cases continue to roll in, Dr. Katherine Reyes, medical
director of Infection Prevention & Control for the Henry Ford
Health System, said she's been troubled by the high number of
hospitalizations in connection with the outbreak. About 83% of
cases have included hospitalization, according to the latest
data from the state.

Other at risk populations include people who have close contact
with someone who has hepatitis A, gay men, travelers to
countries with high or medium rates of hepatitis A and people
with chronic liver disease.

"We have had patients admitted with hepatitis A," Reyes said.
"We have seen a number who come in with symptoms and the
diagnosis is made during admission. We have also had patients
who were transferred to us with known diagnosis of hepatitis A
and are getting transferred for escalation of care. ...This is
tragic."

Response to the outbreak
Multiple counties across the region have taken similar,
proactive approaches to the outbreak. According to the MDHHS,
the best way to reduce the risk of getting hepatitis A is to
receive two doses of the vaccine. Proper hygiene, including
thorough hand-washing, is also urged.

In Detroit, Khaldun said her department has been on the ground
working with not just at-risk populations but also local
hospitals, clinics and individuals who work within the community
such as police and emergency technicians.

In November, health officials announced a case of hepatitis A
had been found in a worker at the Detroit Water and Sewerage
Department but officials said it was a single instance.

"We’ve done over 20 outreach clinics in the community," Khaldun
said. "We also are working internally with various city
agencies. ... We’re actually vaccinating all of the city’s first
responders, EMS, Detroit Water and Sewerage, and the police
department. There's been no indication that those agencies are
the cause of the outbreak or have spread it in anyway but we’re
doing it as precautionary measure. We’re also working with our
food service workers across the entire city."

Detroit Recovery Project, a multi-service agency that has
provided a variety of support services to Detroit's recovery
community for the past 10 years, has been working hand-in-hand
with the city's health department to increase awareness of the
outbreak and reach some of the at-risk population.The recovery
project has two locations, one on the east side of the city and
the other on the west, and averages about 400 to 500 clients a
month, who are battling varying degrees of drug or alcohol
addiction.

"We’re kind of boots on the ground because of the work we do,"
said Andre Johnson, president of Detroit Recovery Project near
McNichols and I-75 . "You see where we’re located, we’re in the
belly of the beast. Hepatitis has been known to be a silent
killer in urban communities for many years. Unfortunately,
Detroit, we get the brunt of everything. So this (outbreak)
doesn't surprise me. ... Our program is about infusing hope and
providing them with the tools to sustain long-term recovery."

http://www.wzzm13.com/news/health/michigan-is-facing-an-alarming- hepatitis-a-outbreak/498581748

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