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Michigan's hepatitis A outbreak now nation's deadliest

Jan 10, 2018

As of last week, Michigan officially has the deadliest of several hepatitis A outbreaks going on nationwide.

According to the Michigan Department of Health and Human Services, at least 22 people have died from outbreak-related cases since August 2016.

California still reports the most hepatitis A cases, with 686 cases and 21 deaths reported in its outbreak, which has been concentrated in San Diego.

But public health officials there say the outbreak seems to be losing steam. Meanwhile Michigan, with about 25 percent of California’s population, is now close to that total with 658 reported cases.

Jay Fiedler, MDHHS section manager for surveillance and infectious disease epidemiology, says there’s no sign the number of reported cases in Michigan is slowing, though it does seem to have “plateaued” recently.

“When I look at the numbers overall, I still see that we tend to be adding about 15-20 cases a week, and we do tend to be getting about the same number of specimens into our laboratory every week for laboratory confirmation,” Fiedler said. “We aren’t really getting the sense that this is going down yet at this point.”

Feidler says the state is still calling this a “southeast Michigan outbreak,” because that’s where the bulk of the cases are concentrated.

However, “We are seeing this kind of start to expand out of southeast Michigan to some extent, with some more isolated cases in counties like Clare and Hillsdale, [and] one in Kent County more recently reported as well,” Fiedler said.

Fiedler says the two more recent hepatitis A deaths reported are from Wayne and St. Clair counties—though in the case of the Wayne County death, the timing is due to a reporting lag. That death actually occurred in early 2017.

Feidler says despite the rising number of deaths, hepatitis A isn’t usually too serious for the average healthy person. “We are seeing deaths more associated with people who have chronic liver conditions, or other conditions that make them more frail,” he said.

Even though hepatitis A isn’t usually deadly, given the outbreak, MDHHS is encouraging people in high-risk categories—such as people with substance abuse problems, men who have sex with men, people who have been incarcerated and people with underlying medical conditions, especially liver problems--to get vaccinated.

While Michigan's outbreak has been linked to those higher-risk groups, it isn't strongly tied to any one of them, and almost 40% of cases is made up of people with no known risk factors. There's also no identified source for this outbreak.