Emergency Department-based Hepatitis A Vaccination Program in Response to an Outbreak

Abstract

(PDPH) declared a public health emergency due to hepatitis A in August 2019. 1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission. This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission. Methods: We conducted a retrospective review of all ED visits in the 12-week period centered around the implementation of the ED-based hepatitis A vaccination program. All adult patients presenting to the ED were offered vaccination, with vaccines supplied free of charge by the PDPH. We compared the incidence of diagnosis and of hospital admission for treatment of hepatitis A before and after implementation of the program. Results: There were 10,033 total ED visits during the study period, with 5009 of them prior to the implementation of the vaccination program and 5024 after implementation. During the study period, 669 vaccines were administered. Before the vaccination program began, 73 patients were diagnosed with hepatitis A, of whom 67 were admitted. After implementation of the program, 38 patients were diagnosed with hepatitis A, of whom 31 were admitted. Conclusion: A partnership between an ED and the local public health department resulted in the vaccination of 669 patients in six weeks in the midst of an outbreak of a vaccine-preventable illness, with a corresponding drop in ED visits and hospital admission for acute hepatitis A.

The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies

“…Additional challenges in outbreak management among at-risk populations were observed at a more systemic level. For example, poor sanitation and/or homelessness have been identified as root causes of outbreaks that need to be addressed ( Supplementary Table 5 and Figure 2 ) [ 37 , 55 , 63 , 75 ].…”

An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak

“…In a Philadelphia-based study analysing ED hepatitis A vaccination rates, the hepatitis A vaccine was offered to all adult patients (5024 patients) regardless of risk factors on arrival to the ED during a 6-week intervention period. 25 If the patient agreed to a vaccine during their clinical visit, an electronic BPA would prompt their physician to order one. During this study period, 669 vaccines were administered (approximately 13 000 per 100 000 patients).…”

Reaching the hard to reach: Characteristics of patients who received a COVID‐19 vaccine in the emergency department

“…ED‐based vaccination programs have proven successful prior to COVID‐19. 8 Likewise, COVID‐19 vaccine distribution in the ED did not negatively affect the normal workflow of the ED, suggesting that the program is sustainable for continued vaccine distribution. After the study period, Janssen vaccine eligibility in New Jersey expanded to all people 18 years and older.…”