GHs, owned and operated by various companies, provide 24-hour care and supervision for up to six residents, who share rooms and bathrooms.Residents have developmental and/or physical disabilities; some are nonverbal or minimally communicative, and some require assistance with toileting. Residents attend various programs at off-site work sites (WSs) including vocational centers for the disabled, a restaurant, and hotel, where they have contact with off-site workers and residents from other GHs or private homes.At a fourth GH (GH-D) in Oakland County, patient 7 became symptomatic on July 5, 2013.

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A second case in GH-A was diagnosed May 16, 2013, in a person who attended WS-A (Table 1).

At a second Oakland County group home (GH-B), three cases were reported among residents, with illness onset dates of May 17(case 3), May 28 (case 5), and May 29 (case 6) (Figure 1).

(Author affiliations at end of text) Hepatitis A virus (HAV) infections among persons with developmental disabilities living in institutions were common in the past, but with improvements in care and fewer persons institutionalized, the number of HAV infections has declined in these institutions (1).

However, residents in institutions are still vulnerable if they have not been vaccinated.

Ages of patients ranged from 42 to 61 years, with an average age of 48 years (median age = 48 years).

Seven of the eight patients were male; three of the five homes housed only males.

After the hepatitis A diagnosis in a GH-A resident, the Oakland County Health Division (OCHD) began an investigation on April 24, 2013, to identify the source of infection and to prevent HAV transmission to other residents and staff.

For purposes of this investigation, a confirmed case of hepatitis A was a case meeting the Council of State and Territorial Epidemiologists case definition for acute hepatitis A ( in a person who resided or worked at an adult GH or WS during April 16–September 18, 2013.

Two GH-E residents worked at WS-D, the same vocational center that patient 6 attended.

Patient 8 attended a special needs camp in Tuscola County during June 30–July 12, 2013.

After the occurrence of case 8, no further hepatitis A cases were detected among contacts.