1. 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

2. 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

3. 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.

4. 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

6. 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

7. 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

9. 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

10. 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

11. 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