Multistate Hepatitis A Outbreak: Vaccination of Food Service Workers as Part of the Kentucky Outbreak Response

Abstract

Background: In August 2017, a local outbreak of Hepatitis A was identified among homeless individuals in Louisville, Kentucky. This marked the first cases in what has now become recognized as the largest Hepatitis A outbreak in the US. When infection was identified in a Food Service Worker (FSW), vaccination efforts were expanded to target this group. Objectives: The purpose of this study was to describe: 1) the processes used to provide access to Hepatitis A vaccine for FSWs, 2) results from the immunization activities, and 3) lessons learned from the outcomes. Methods: Through a partnership between the Louisville Metro Department of Public Health and Wellness (LMDPHW) and the University of Louisville Division of Infectious Diseases (UL), a novel approach to vaccination was implemented. Access to vaccine was provided via on-site immunization in 66 restaurants and subsequent availability in a pop-up vaccination clinic. Data were collected using the LMDPHW data collection form and included demographics, risk factors for Hepatitis A, and vaccine documentation. Results for those vaccinated March-December 2018 were analyzed using descriptive statistics. Results: On-site vaccination was provided to 1337 FSW at 66 restaurants during the seven (7) week period from March 28-May 15, 2018. This process involved a team of 42 including Advanced Practice Registered Nurses, Registered and Licensed Practical Nurses, Physicians, and UL team members. During the 35 weeks the walk-in clinic has been in operation (May 16-December 31, 2018), 3068 additional FSW were vaccinated for a total of 4405 FSWs vaccinated as part of the outbreak response. Critical partners included the Kentucky Restaurant Association and the Kentucky Nurses Association. Conclusions: This study demonstrated a successful model for vaccination of a novel population during an infectious disease outbreak and the importance of expanding partnership networks to ensure success. The outcomes emphasized the importance of the resources available in the academic community for reliable and consistent public health emergency response. DOI: 10.18297/rgh/vol2/iss1/6 Submitted Date: January 25, 2019 Accepted Date: March 01, 2019 https://ir.library.louisville.edu/rgh/vol2/iss1 Affiliations: 1University of Louisville, Global Health Center, Division of Infectious Diseases, University of Louisville School of Medicine 2Galen College of Nursing, Louisville, KY 3Kentucky Nurses Association, Louisville, KY This original article is brought to you for free and open access by ThinkIR: The University of Louisville’s Institutional Repository. It has been accepted for inclusion in The Journal of Refugee & Global Health by an authorized editor of ThinkIR. For more information, please contact thinkir@louisville.edu. Recommended Citation: Carrico, Ruth M.; Balcom, Dawn; Mason, Delanor; Denker, Audria G.; Holland, Alyson; Buckner, Kimberley A.; Furmanek, Stephen P.; and Trail, Wesley (2019) “Multistate Hepatitis A Outbreak: Vaccination of Food Service Workers as Part of the Kentucky Outbreak Response,” Journal of Refugee & Global Health: Vol. 2 : Iss. 1 , Article 6. *Correspondence To: Ruth M Carrico PhD DNP APRN FNP-C FSHEA CIC Associate Professor Phone: 502-852-6485 Email: ruth.carrico@louisville.edu Original Research Copyright: © 2019 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. who may be handling or preparing food for consumption. Identification of infection in a food service worker (FSW) also brought awareness regarding the ability of this disease to manifest itself more broadly in the general population. This served as motivation to expand vaccination efforts and target those working in the more than 3000 restaurants and food service facilities in Louisville. There was also concern regarding the perception of risk of transmission via food in the wake of planning for the Kentucky Derby, an international event that attracts close to a million visitors to the state during April and May. Typically, hundreds of food trucks and mobile restaurants also enter the Louisville area as part of the Kentucky Derby Festival. This was a driving factor to expand vaccination efforts and garner assistance that could augment traditional public health emergency response operations and the human and material resources necessary to improve vaccination capacity. Since early 2000, emphasis has been placed on development and training of groups of individuals with expertise in aspects of healthcare emergency response so they could be quickly called into action for assistance. These groups compose the community Medical Reserve Corps and significant resources are devoted to their training. However, response rates among those trained may be inconsistent leaving communities, including Louisville, with unfilled needs in the wake of emergency situations that require rapid and broad response. The Hepatitis A outbreak in Louisville was another demonstration of this gap and, combined with the decreasing capacity within the traditional public health system, resulting in the inability to implement the robust response needed for vaccination and education of the disenfranchised populations at the heart of the outbreak. In response to this capacity need, the Louisville Metro Department of Public Health and Wellness (LMDPHW) reached out to the University of Louisville Global Health Center (UL-GHC) for assistance in planning and implementation of a community-wide vaccination response targeting FSWs. The objectives of this report are to describe: 1) the processes used to provide access to Hepatitis A vaccine for FSWs, 2) results from the immunization activities, and 3) lessons learned from the outcomes