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Hepatitis B/C Outbreak in Marshall County

This scenario describes a Hepatitis B/C outbreak in Marshall County, involving a 49-year-old male patient who presented with acute symptoms on August 6, 2003. The outbreak investigation involves contact tracing, identification and testing of contacts, and implementation of control measures including prophylaxis and education.

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Hepatitis B/C Outbreak in Marshall County

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  1. Hepatitis B/C Outbreak in Marshall County Thein Shwe Amber Riba August 6, 2003

  2. Scenario • 49 yr. Old male patient presented to ER with acute symptoms of hepatitis on 11-15-01. Symptom onset date: 11/12/01 • Tested for hepatitis panel • IgM anti-HAV – borderline • HBsAg – positive • IgM anti-HBc – positive • Risk factors: intravenous drug users

  3. Step 4b: Identify and Counting Cases • Contact Tracingby DIS, LHD and RE • 6 needles sharing contact with index case (OxyContin) • More contacts identified • Needle sharing contacts • Sexual contacts • Household contacts • Total of 32 contacts were identified and tested • Age: 14-49 years old

  4. Step 4b cont. • 6 people met acute case definition -10 HBs Ag and IgM Anti-HBc positive -18 Hepatitis C antibody positive (2 confirmed, one high s/co ratio and 1 RIBA confirmed) -2 Hepatitis A positive (both –borderline) -5 Hepatitis B/Hepatitis C coinfection -2 Hepatitis A/Hepatitis B/Hepatitis C coinfection (index case)

  5. Step 2 Establishing the Existence of an Outbreak

  6. Step 9 Control Measures • Prophylaxis • 2 contacts - HBIG given • 2 contacts – IG for Hepatitis A • 12 household, sexual and needle sharing contacts - Hepatitis B vaccines • One pregnant woman – finished her last dose of HB vaccine after delivery • LHD – provide the report of test results including the explanation of test results to contacts and cases • Education about hepatitis A, B and C

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