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How creating a map drove a bigger hepatitis story Date: 02/13/18

Lauren Weber

By Lauren Weber

It's hard to believe that in 2018, a deadly vaccine-preventable disease that is most commonly spread through poor sanitation is taking American lives. But that's exactly what has happened over the past year. In September, Dana Liebelson and I reported the story on San Diego's unprecedented hepatitis A outbreak — where it has sickened 576 people to date and killed 20, most of whom were homeless or drug-users.

Hepatitis A, a possibly fatal disease that attacks the liver, was primarily foodborne in the U.S. until these recent outbreaks. But in San Diego's case, the disease was being spread by contaminated feces, forcing the city to wash the streets with bleach and hand out plastic poop bags. Critics saw this as merely a stopgap ignoring the complex housing and sanitation factors at play.

While the gravity of the situation in San Diego caught national headlines for the nature of the sanitation aspect, we were the first to report the scoop that separate outbreaks were happening across the country, from Michigan to New York — they just weren't getting national media attention. This was more than just a local malfeasance turned deadly; it was a broader trend nationally among homeless and drug-using populations.

We figured this out from some good old fashioned source-building, by calling around San Diego health experts until one let on this wasn't just happening in California. So, with that in mind, I approached Alissa Scheller, our amazing visuals editor at the time (she has since moved to Pew Research), to show just how bad the situation had gotten for a follow-up piece relying heavily on visuals that would focus more on revealing the hidden national picture.

Initially, I had planned to do a quick graphics follow-up on the San Diego piece, highlighting via a map where the outbreaks were nationwide with a short accompanying write-up. The plan was simple – the visual would demonstrate that California was not alone and that the state’s outbreak was not isolated. But once Alissa and I took a look at the CDC’s MMWR (Morbidity and Mortality Weekly Report) on the state-by-state hepatitis A numbers, it was clear we had a larger story on our hands. My idea quickly morphed into a full-blown feature once the numbers showed how dire this health crisis had gotten – hepatitis A cases were up 28 percent nationally from November 2016 to November 2017.

I started with my sources from my last related story, interviewing public health experts in California and then calling the health departments of all other major U.S. cities affected, as well as the National Association of County and City Health Officials to get a better sense of the bigger picture and what cities were doing around the country to prepare and combat these unprecedented outbreaks.

HuffPost’s Lauren Weber and her colleagues tracked the increase
in hepatitis A cases across the country, noting surges beyond
California. Click to enlarge. (Graphic courtesy of HuffPost)

I was shocked to discover that each state only gets $90,000 from the U.S. Centers for Disease Control and Prevention (CDC) for combating viral hepatitis, which includes hepatitis A, B and C – a family of diseases that are much less expensive to prevent than they are to treat. On top of that, through interviewing multiple city health officials, it became clear there was a "constrained shortage" of vaccine, meaning supplies were limited and some delays in delivery were to be expected – not something anyone wants to hear when there's an ongoing outbreak. Each of the pharmaceutical companies that manufacture the vaccine confirmed my scoop. Various public health officials consistently stressed that limited public health funds were hamstringing prevention efforts and that the limited supply of vaccine could cripple future prevention efforts. For example, Seattle, which has the third-largest homeless population and is thus vulnerable to a potential outbreak, was only receiving some of the just 40 vaccines allocated to Washington each month.

So, on top of the scoops, it then came down to making sure we were visually showing just how much of a problem this was across the United States. The hardest part was making sure all the numbers translated to the page when it came to the timeline. Alissa had to make sure that since each of these outbreaks had separate start dates – some in 2016, some in 2017 – the data we represented was starting from the same timeframe. I had started off wanting a map, but once I realized the percentage of case increases from last year, I asked Alissa to create a line graph comparing the last two years to show the steep uptick, as well as ones showing the jumps in the hardest-hit states.

The visualizations really made this story come alive. The point was to show that California’s outbreak wasn't isolated, and our various graphics made the disease’s reach very clear: the hepatitis A outbreak is a major public health crisis – and it's far from over.

Lauren Weber (@LaurenWeberHP) reports on a variety of global and national public health issues for HuffPost, from tuberculosis and malnutrition to rural hospital closures and antibiotic resistance. She is also the creator and editor of The Morning Email, HuffPost's weekday rundown of the news that you need to know for the day. You can also hear her as HuffPost's morning news voice on Amazon Echo.