Hepatitis-A Case Strengthens Partnerships and Exercises Epidemic Response

Submitted By

Karen McKinnis and Andee Coble
Springfield-Greene County Health Department, Missouri
February 6, 2015

On May 20, 2014, the Springfield-Greene County Health Department learned a local restaurant employee tested positive for Hepatitis-A and that customers were potentially exposed. The exposure period unfortunately overlapped with Memorial Day, setting into motion a quick response involving local partners and 5,000 restaurant customers. The incident provided local public health partners with an opportunity to exercise epidemic response readiness. Karen McKinnis, Director of Administration, and Andee Coble, Public Health Planner, shared details of the Springfield-Greene County Health Department’s response during a recent interview with NACCHO. Their story is captured below.

Per Centers for Disease Control and Prevention guidelines, those potentially exposed to Hepatitis-A need to be vaccinated within fourteen days of exposure and should have a second vaccination six months later. Springfield, with a population of 159,000, is Missouri’s third largest city and a local hub for neighboring communities for shopping, transportation, and health care. The area is also home to numerous colleges, seminaries, and a campus of Missouri State University, creating a wide base of potentially exposed customers. The health department learned about the infected employee several days before Memorial Day weekend and needed to act quickly to reach people who might have had travel plans for the holiday.

"Our main goal is to keep positive partnerships so when things happen we can tackle them right away,” said Ms. Coble as she described the rapid response to news of the infected employee. The restaurant worked closely with the health department and, together, they determined 5,000 people were potentially exposed.

Within one day, the health department and county office of emergency management coordinated and executed a response. A call center, manned by the department staff and volunteers, was immediately set up not only to provide information about the disease and prophylactic vaccine for the exposed, but also to answer questions from non-exposed community members. The call center approach was very effective at screening out the worried well because the center had trained staff to answer questions and alleviate fear. In addition, the Springfield-Greene County Health Department coordinated vaccine delivery with the state of Missouri, issued a press release, held a press conference, and communicated with local television, print, and social media to get information out to the public about free vaccination clinics. The health department’s immunization coordinator fanned information out to other public health agencies across the region about vaccine availability and prophylactic time frames, taking into consideration that not all exposed persons lived in the local Springfield area (calls came in to the call center from as far away as Hawaii). A plan was developed for the county to sponsor vaccination clinics and Springfield’s two major hospitals (Mercy and CoxHealth) offered to be additional vaccination sites.

Within 48 hours of learning of the potential exposure, the health department opened a two-day free clinic for prophylactic vaccination at a local event center. The staff of the event center partnered to provide logistical support and the Red Cross provided refreshments for patients and staff. Over 2,000 people were vaccinated during this two day event. Nearly 500 additional people were vaccinated by Mercy and CoxHealth over the three day Memorial Day weekend. Other local health agencies that had been contacted by Springfield’s immunization coordinator vaccinated an additional 920 people. Ultimately, this well coordinated response was a huge success, as there have been no reported secondary exposure cases resulting from the restaurant worker’s illness.

The Hepatitis-A vaccination requires a second dose six months later to be fully effective, and the health department planned to provide it to those vaccinated during the May events. Ms. McKinnis and Ms. Coble realized these six month vaccine booster clinics created an excellent opportunity to simultaneously conduct an epidemic readiness exercise, incorporating lessons learned from the first event.

The six month booster provided a “perfect opportunity to not only show improvement on weaknesses or deficiencies we identified in our initial response but also to exercise new capabilities,” said Coble. The health department used their immunization database information to contact those previously vaccinated and used automated reminder calls to provide information about the booster clinic. The health department also provided education about the vaccine itself (e.g., special instructions for pregnant women). As a result of their efforts, over 800 people were vaccinated at the health department’s follow up clinic, unaware an exercise was simultaneously being conducted. This "behind the scenes" exercise model has worked well for the health department and they have organized similar exercises during local shingles and flu vaccination events.

Coordination between all parties -- the local health department, business, hospitals, and media safeguarded the community against secondary Hepatitis-A cases. Ms. McKinnis and Ms. Coble stressed appreciation for the restaurant’s cooperation and ties it to their department’s goal of maintaining “that positive relationship and an environment of education and trust” with partners to protect the public’s health.

Agnes Jensen, who authored this article, is a Local Public Health Policy & Practice Scholar at NACCHO and a Masters of Public Health student at University of Minnesota.

Leave a Reply

Your email address will not be published. Required fields are marked *