Since November 2016, when a countywide hepatitis A outbreak was first detected, 507 people have been infected, 19 (3.7 percent) have died, and more than 80,000 others have been vaccinated, county health authorities said.
Hepatitis A is a liver infection caused by the hepatitis A virus, which is highly contagious. It can cause liver disease, lasting a few weeks to a serious illness lasting months. In some cases, it can be fatal.
Contamination can occur when persons infected with hepatitis a do not wash their hands properly after going to the bathroom, then touch other objects or food items. Hepatitis A virus does not always cause symptoms. Some with the virus have no symptoms — fever, fatigue, nausea, loss of appetite, yellowing of the eyes (jaundice), stomach pain, vomiting, dark urine, pale stools and diarrhea. Adults are more likely to have symptoms than children.
Additionally, county health reported roughly two-thirds of the victims have been homeless and/or illicit drug users. That makes the task of combatting the disease a real challenge, said Dr. Wilma Wooten, public health officer for the County of San Diego.
“It’s (homeless/drug abusers) a difficult-to-reach population,” she said. “So we’ve had to creatively go where they are (on the street) because these people typically don’t go to health clinics. We’ve put out teams of public health nurses and law enforcement homeless outreach officers to help us vaccinate those people.”
The ongoing hepatitis outbreak was unexpected.
“Typically, every month we have two to three cases of hepatitis A that is travel-related, associated with someone who has gone to a country where there is a high prevalence of the disease where they can get exposed to it, and then bring it back with them,” said Wooten noting, “It (hepatitis) has a long incubation period — 15 to 50 days.”
Wooten said there was a spike in hepatitis A cases starting this March, which prompted her to declare a local public health emergency. And, because infections are most common among the homeless who often have no access to sanitary facilities, the county’s efforts began turning toward installing hand washing stations and doing street cleaning in early summer.
One theory advanced to explain the present hepatitis outbreak, is that California’s discontinuation of single-use plastic bags has helped spread the disease. Many people have discounted the plastic-bag theory, but not Wooten.
“Yes, absolutely, we know people use the bags for that (defecation),” she said. “We know people don’t have bathrooms and they can put bags in cans and buckets and maintain good hygiene. That’s why we put plastic bags in the hygiene kits we’re handing out. That’s what we expect people will use them for.”
The San Diego County Public Health Officer strongly recommends the following groups be vaccinated with the hepatitis A vaccine:
People who are homeless.
Users of illegal drugs.
Men who have sex with men.
People with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C.
People who work with, provide services to or clean up after the homeless and/or illegal drug users Food handlers who have adult clients. Food handlers are not at increased risk, but if infected can impact a large number of people.
People with clotting factor disorders.
People who conduct laboratory research with the virus.
Travelers to countries where hepatitis A is common.
People in close personal contact with adopted children from countries where hepatitis A is common. Wooten said the county has employed a three-pronged approach to addressing the hepatitis outbreak: vaccination, sanitation, and education.
“As of today, we’ve vaccinated almost 84,000 individuals since we identified the outbreak in March,” she said adding, “We’ve also been installing hand-sanitizing stations throughout the city and county, as well as cleaning and bleaching the sidewalks, using the same vendor as the city of Los Angeles, which has more homeless than San Diego, but has not had a hepatitis outbreak. We also have introduced a public education campaign with posters on trolleys.”