Lessons Learned: Social Media Helps End Hepatitis A Outbreak in Toronto

October 31/2019

by: Roshaneh-Fatema Jaffer, Communications Work-Study Student at DLSPH

Men who have sex with men in Toronto were at higher risk of contracting hepatitis A following an outbreak in 2017. Social media helped stop the spread, a study found.

DLSPH resident physician Mike Benusic was on a communicable disease rotation when the end of the outbreak was declared. He took part in writing Toronto Public Health’s outbreak report which outlines their strategy from 2016 to 2018.

“We typically see a lot of cases in people who have travelled to areas where there is a lot of hepatitis A, and then they come back. In late 2016 to early 2017, however, outbreaks popped up in Europe and the US,” said Benusic, a resident of the Public Health & Preventive Medicine program.

“When analyzing the data, Toronto had the same number of cases as usual, but the proportion of risk factors were different. When epidemiologists looked deeper, 40 per cent of those cases were men who have sex with men compared to the usual four per cent.”

The infection rates were too high. Epidemiologists presumed that the transmissions were local and perhaps through sexual contact. As they dug deeper into the data, their suspicions were confirmed. The Toronto Public Health team immediately mobilized to contain further infections.

Bringing together a full roster of epidemiologists, sexual health clinicians and a communications expert, the team’s main goal was to increase immunization. They set up clinics near the village, Toronto’s predominantly LGBTQ2S+ neighbourhood. They also developed a public relations campaign. While e-alerts were sent to healthcare providers, social media proved to be useful in promoting vaccine uptake.

“The social media outlet that was most impactful in this outbreak was suggested by our media expert. She suggested using Grindr, a popular dating app for men who have sex with men, to use ads that are spatially targeted,” said Benusic.

With Pride 2018 around the corner, the Toronto Public Health Team acted fast. They released targeted alerts on Grindr for anyone in proximity to the village. App users would see a pop-up ad when they opened the app warning them of their risk of exposure. The ad also contained information on the clinics to visit to receive the vaccine for free.

The team used other social media platform but saw tangible success with Grindr. Click-through rates reached 1.4 per cent or were seen 1,186,369 times on Grindr alone. Campaigns may see 0.1 per cent click-through rates, says Benusic. In real time, orders for the vaccine increased between June 2017 to November 2018, much higher than January 2012 to May 2017. In fact, a total of 105 vaccines were given at six clinics in early 2018. Only four new cases were reported after Pride Toronto 2018. The outbreak was declared over in November 2018.

The intervention took two years rather than a few months. The hepatitis A vaccine is offered to travelers visiting places where the infectious disease is prevalent, those who use intravenous drugs, men who have sex with men, or people living with pre-existing liver disease. Also, herd immunity — when a population is completely immune from a disease since there is a high proportion of people who are vaccinated — is not easy to achieve. Benusic says that roughly 70 per cent of men who have sex with men would have needed to be vaccinated to prevent further infections during the Toronto outbreak.

Although the team successfully controlled infection rates, Benusic says the approach won’t work for all sexually transmitted diseases and infections.

“There is no easy way to fix a hepatitis A outbreak. When it’s a food source, then it’s easier to control. When there’s a high suspicion that it’s sexually transmitted, there needs to be behavioural change and it’s not always as easy as convincing people to get vaccinated,” said Benusic.

The Toronto Public Health’s team released its plan and lessons learned. Read the report here.