Health workers aim to put end to hepatitis A outbreak

Allison Seidel, MPH, who is pursuing a DrPH in epidemiology at the Colorado School of Public Health, is taking the fight against hepatitis A to the front lines in Denver through an innovative mobile clinic with one goal: end the outbreak.

In June, the highly contagious liver infection, which has flared in parts of the Midwest and South, was confirmed in the first outbreak-related Denver patient, and efforts are underway to contain it. It is preventable through vaccination, but it is not a straightforward solution.

The current hepatitis A outbreak has primarily affected people experiencing homelessness and people who inject drugs, and vaccinating this population can be tricky.

Communicable disease

Mobile clinic workers include, from left, Ola Bovin, Allison Seidel and Maggie McClean. Seidel is pursuing a DrPH in epidemiology at the Colorado School of Public Health.

The hepatitis A virus is spread through fecal to oral transmission, and is known as a foodborne-related illness. It usually occurs in populations with poor health or living in unsanitary environments.

“It can affect people who don’t have the means to clean themselves,” said Seidel, an epidemiologist with Denver Public Health. “This makes people experiencing homelessness particularly at risk for the disease.” 

Fortunately, it is not a death sentence for most people. Hepatitis A can be treated, though it comes with a myriad of painful symptoms including jaundice, cramps, aches and nausea.

Kentucky and Ohio have been hardest hit by the outbreak, with over 4,800 cases and 3,200 cases, respectively. There have been 163 confirmed cases in Colorado, and the first death was confirmed just recently.

Vaccines are the answer

The best way to treat hepatitis A is to avoid it altogether through the vaccine, which became a childhood vaccine in 1996.

“Even if someone has been exposed to hepatitis A, he or she still has two weeks to get vaccinated and avoid the disease,” Seidel said. “The vaccine is given in two doses. The first dose gives immunity for up to 10 years and the second dose gives immunity for life.”

Disease detective

Seidel is the operations chief of the event co-led by Denver Public Health, a partner of Denver Health, and the Denver Department of Public Health and Environment to eliminate the hepatitis A outbreak. Think of Seidel as a disease detective; she tracks the disease, makes predictions about where it could go next, and helps brainstorm how to stop it in its tracks.  

“The current outbreak is being mitigated using vaccination efforts,” she said. “But the conversation and efforts about addressing homelessness in Denver still remains, and we are continually addressing it.”

The goal of the project is to end the outbreak through herd immunity, or vaccinating so many people that the disease is unable to spread, Seidel said. However, the goal is not as straightforward as it sounds.

Mobile clinics

People experiencing homelessness are predictably transient, making identification of potential patients difficult. To combat this, Seidel and her team are traveling across Denver using a “mobile clinic” to reach a broader population.

The location of the mobile clinic changes daily and is based on where the outbreaks are happening. Those working at the mobile clinic ask people if they are aware of the outbreak and whether they are willing to be vaccinated. They set up with banners to draw attention and offer bottles of Gatorade and water as an incentive to become vaccinated.

Casey Hawkins gives a hepatitis A vaccination to a man in downtown Denver. Hawkins graduated with her MPH from the Colorado School of Public Health last May.

“We like to choose our locations where it is convenient for our target population,” she said. “We have a car that we can drive around and park it with our supplies close by. We then dispatch a team to vaccinate patients.”

A specific challenge to this project is the high turnover rate of those experiencing homelessness in Denver; upwards of 40% of the population will leave and a new group of people – potentially unvaccinated – come in each year.

How long will the mobile clinic effort last?

 “It’s hard to predict,” Seidel said. “Until we have zero patients for 100 days, we will continue our efforts.” 

If you are interested in volunteering with Seidel and her team, please contact her at allison.seidel@dhha.org or 303-602-3587.