Hepatitis A Outbreak Management Dawn Bailey Head of Public Health, Health Protection Leeds City Council Mike Gent Public Health England, Yorkshire and Humber, Deputy Director of Health Protection

Hepatitis A A viral infection Spread through ‘Faecal-oral’ route Symptoms are similar to flu Vaccine preventable Good hand hygiene Many young children are asymptomatic

Background July 2015 a PHE Centre reported a small number of a hepatitis A in the LS 9 area of Leeds. In July 2015 a multi-agency Outbreak Control Team (OCT) was established. Genetic sequencing of the virus confirmed cases were linked By the end of November 2015 a total of 18 confirmed cases recorded in the area.

Context First significant outbreak in Leeds since H and SC reforms 2013. 2 defined geographical areas in a deprived part of East Leeds High proportion of migrant communities Overcrowding, poverty, language barriers Children playing in the streets over the summer holidays Poor compliance with contact tracing

Outbreak Control Group! Colindale PHE Centre LCC public health locality team LCC Environmental health LCC Emergency Planning LCC Local Area Team PHE and LCC Comms NHS England Screening and Immunisation team Schools health and safety team Uncle Tom Cobbly PHE Y&H Centre (Chair) LCC Public health – Health Protection -Support to Chair North CCG primary care South and East CCG primary care North CCG Medicine optimisation team South and East CCG Med opt team LCH School Nursing

Interventions Vaccination programme in a local clinic Community awareness through voluntary sector Promoting hand hygiene in schools GP mop up Vaccination clinics on a Community Bus School vaccination campaigns in two local primary schools

Achievements 1,400 vaccines given in total Effective working across a very complex system System worked as a whole, despite the number of organisations involved All sections of the system demonstrated a ‘can do attitude’ Greater mutual understanding of different parts of the system

Learning Complexity of the system, needs (lots of) time to manage Roles and responsibilities - greater clarity Effective communication across the system essential Involving the right people at the right time Capacity of provider organisations to respond is much reduced Competing priorities for organisations (seasonal flu vacs delayed) Amount of commitment and goodwill across the system can’t last forever

Developments since outbreak House of Commons Health select committee Development of Leeds Migrant health strategy Still no national guidance on lead commissioners, who pays or how to mobilise services. Leeds Outbreak plan developed 2017 Developing local agreements between organisations on roles and responsibilities for outbreak planning