Hundreds of people at risk of hepatitis A infection, amid a national outbreak, received vaccinations through an innovative program that started last fall at UCHealth.

When a patient receives care in the emergency department of any UCHealth hospital across Colorado, certain information in their electronic health records – such as homelessness – can trigger an order for the potentially life-saving vaccine.

UCHealth vaccinated more than 350 people to-date through the initiative, which went live at all the hospitals by early December. The process also pulls information to ensure the patient wasn’t already inoculated.

“It opens your eyes, because I thought – just wow – we really have that many people who we see who are at risk,” said Dr. Michelle Barron, an expert on infectious diseases and medical director for Infection Control and Prevention at UCHealth University of Colorado Hospital.

Most insurance plans cover the vaccine’s cost. But UCHealth makes sure price doesn’t get in the way for any of the patients at elevated risk.

“We as an organization decided it was important enough that if there are folks that are self-pay or not insured with Medicaid or elsewhere, that we would bear the burden of the cost,” said Dr. Kelly Bookman, senior medical director with the UCHealth Emergency Medicine Service Line.

The hepatitis A outbreak in Colorado

The virus causing hepatitis A, an inflammation of the liver, most often spreads through food or water that has been contaminated by infected stool. It can also spread from person to person. Symptoms include fever, fatigue, jaundice (yellowing of the skin and whites of the eyes), upset stomach, vomiting, diarrhea and more.

The national hepatitis A outbreak affecting 32 states since 2016 has led to at least 30,696 cases, 18,604 hospitalizations and 307 deaths, according to the Centers for Disease Control and Prevention. The outbreak in Colorado began in October 2018 and has led to at least 347 cases, 248 hospitalizations and two deaths, according to the Colorado Department of Public Health and Environment.

Hepatitis A vaccine

In addition to homelessness, risk factors that can trigger the vaccination order through the UCHealth initiative include incarceration, liver disease, drug use and more.

“I thought it made good sense from a public health standpoint and also a hospital standpoint,” Barron said of the initiative, pointing to the rate of hospitalizations. “Some have gotten incredibly sick.”

She said the emergency department isn’t the ordinary setting for giving vaccines like this.

“Most care is really focused on that specific problem,” she said. “It was a little novel in its approach.”

Hepatitis A transmission

CDPHE Communicable Disease Deputy Branch Chief Nicole Comstock said people experiencing homelessness, substance abuse issues and incarceration are especially susceptible.

“The populations primarily affected by this outbreak can be hard to reach by traditional public health outreach practices, so we are grateful for UCHealth’s partnership in working toward our goal of ending this outbreak,” she said.

“When we have, say, an outbreak in a school or an outbreak in the community, we rely on mass media – news articles, social media, that type of thing – and sometimes, the populations experiencing homelessness may not have Facebook or check news or TV, newspapers, press releases or something like that.”

The state reports the cases from Colorado’s hepatitis A outbreak are spread across 18 counties. Most are in the Colorado Springs and Denver areas, but the report identifies a few as far as Montezuma, Mesa and Routt counties.

After reaching a peak of 18 newly-reported cases one week in late September, the number of new cases of hepatitis A infection in Colorado appears to be going down.

“We started seeing a decline in reported cases in the fall of 2019; however, we are still reporting between five to 10 new cases each week, so the outbreak is not over,” Comstock said. “We’re cautious, and we want to remain vigilant in keeping our vaccine efforts going until we’re back to our baseline rates.”

She said the at-risk groups tend to move frequently to different geographic areas, and the turnover appears to become more frequent in springtime.

Hepatitis A treatment

“Providing hepatitis A vaccine to at-risk groups remains the cornerstone of this response,” Comstock said.

The state reports that more than 22,000 vaccines have been given through public health funding sources recorded in a statewide system.

To flag potential vaccine recipients in health care settings, UCHealth electronic health records experts not only developed a program to use across its emergency departments – they shared it with multiple other Colorado hospital systems.

“The algorithm makes it very easy to identify these individuals,” Barron said. “It’s one of the things that I feel really excited about.”

Many hours of physicians’ and analysts’ time went into building the UCHealth program.

“We weren’t worried about the cost,” Bookman said, adding that the initiative was driven by concerns for public health.