Michigan is not most at risk for hepatitis A, but the state has begun warning residents about the widespread outbreak it and surrounding states are experiencing.

The Michigan Department of Health and Human Services (MDHHS) says it is “encouraging residents to be aware of the associated risk factors, the importance of handwashing and the available vaccination to prevent the hepatitis A infection.”

MDHHS reports 920 hepatitis A cases, with 80 percent requiring hospitalization, since the outbreak began in August of 2016. Michigan also reports 30 deaths from hepatitis A infections. MDHHS says although many cases occurred earlier in the outbreak, it is important for residents “to remain diligent in awareness around hepatitis A.”

Public health messages about hepatitis A usually are directed at populations believed to be most at risks, such as IV drug users and people living on the streets. Michigan’s new warning to residents at large likely says something about the size and duration of the hepatitis A outbreaks around the country.

MDHHS reports seven recent acute cases of hepatitis A have occurred in Kalkaska, Grand Traverse, and Antrim counties in the Northwest lower Michigan. Those cases did not involve the Michigan outbreak strain, but one that has been circulating nationally.

Some of those individuals were “substance users,” which makes them part of an at-risk group.

“Although Michigan has not seen the number of cases of hepatitis A that we have during the height of the outbreak, it is essential that people with risk factors for hepatitis A continue to be vaccinated,” says Dr. Joneigh Khaldun, MDHHS’s chief medical executive.

Since the outbreaks began in 2016, 30 states have reported cases to the federal Centers for Disease Control and Prevention in Atlanta. As of Sept. 20, total cases have reached 26,013 with a 60 percent hospitalization rate. The number dead from hepatitis A infections stands at 262.

CDC says when hearing about hepatitis A, many people think about contaminated food and water. However, in the United States, hepatitis A is more commonly spread from person to person.

The people most at risk for hepatitis A infections include:

• People who use drugs, injection or non-injection.
• Homeless or people in unstable housing.
• Men who have sex with men.
• People who are currently or were recently in jail or prison.
• People with chronic liver disease, including cirrhosis, hepatitis B, or C.

All states are reporting some patients that do not fall into any of the high risk groups. Many states are reporting restaurant employees and foodservice workers who have tested positive. As a result, some health departments have had special vaccination programs to offer post-exposure treatment, which much be given within two weeks of exposure to be effective.

State-Reported Hepatitis Cases and Clinical Outcomes

NR: not publicly reported

1. “Outbreak-associated” status is currently determined at the state level in accordance with each state’s respective outbreak case definition.
2. Outbreak-related hepatitis A deaths are defined at the state level in accordance with each state’s respective hepatitis A-related death definition. Some states are reviewing death certificates on a regular basis to actively find hepatitis A-related deaths, while other states are using passive surveillance.
3. Outbreak start dates are defined at the state level and may represent the earliest onset date of an outbreak case (AR, AZ, UT), the left censor date for which cases are considered part of the outbreak based on the state outbreak case definition (AL, CA, CO, FL, GA, ID, IL, IN, KY, LA, MA, MI, MN, MO, MS, NV, NH, NJ, NC, OH, PA, SC, TN, VA, WA), or when a state declared a hepatitis A outbreak (NM, WV).