P-1272. Hepatitis A Investigation and Onsite Response in a Retirement Facility, New York City, 2023

Abstract Background Hepatitis A is a contagious liver infection that can be transmitted by contaminated food consumption. On August 13, 2023, a healthcare provider notified the New York City Health Department of a hepatitis A case in a food handler who worked at a retirement facility while infectious. Medical frailty, mobility, and transportation limitations complicated exposed persons’ access to postexposure prophylaxis (PEP) within the recommended 2-week window. During the COVID-19 pandemic, the Health Department developed capacity to provide onsite SARS-CoV-2 testing and vaccination services within congregate settings to prevent and respond to outbreaks. We used this infrastructure to deliver timely PEP to contacts and prevent an outbreak. Methods Using a risk-assessment algorithm, we evaluated the food handler’s hand hygiene, type and quantity of food prepared, and contact with ready-to-eat food. Anyone who ate food the worker prepared while infectious, defined as 2 weeks before symptom onset, was considered exposed. Following Advisory Committee on Immunization Practices guidance, 1 dose of single-antigen hepatitis A vaccine was advised for exposed adults, with coadministration of 0.1 mL/kg human immunoglobulin (IG) for those age > 40 years. Food handlers were required to receive PEP to prevent workplace exclusion. To enable timely PEP receipt, the Health Department worked with facility staff and a vendor to host an onsite clinic on August 23, 2023. Results We identified 84 exposed persons, including 42 (50%) residents, 10 (12%) food handlers, and 32 (38%) staff. Median age of those exposed was 74 years (interquartile range [IQR]: 58–88 years); residents’ median age was 89 years (IQR: 84–91 years). Of 84 exposed persons, 39 (46%) received PEP; 30 (77%) received vaccine and IG, 1 (3%) IG only, and 8 (21%) vaccine only. Seven exposed persons who received only vaccine were eligible for IG. All 10 (100%) exposed food handlers, 18 (43%) residents, and 11 (34%) staff received PEP. One secondary case was identified in a resident who declined PEP. Conclusion This intervention ensured residents were protected and prevented work exclusions. Providing timely, accessible clinical services within congregate settings, as was commonly done for COVID-19, might effectively prevent the spread of other infections. Disclosures All Authors: No reported disclosures