Hep­ati­tis fight in­ten­si­fies

L.A. County urges more peo­ple to get vac­cines as cases grow among gay, bi­sex­ual men

Los Angeles Times - - CALIFORNIA - By Soumya Kar­la­mangla and Gale Hol­land

Cal­i­for­nia health of­fi­cials have stepped up their hep­ati­tis A pre­ven­tion ef­forts in re­cent days as new fronts emerge in the bat­tle against the state’s mas­sive out­break.

Most of the 20 peo­ple killed and more than 600 sick­ened in the out­break that be­gan in San Diego were home­less. But cases have be­gun to surge in Los Angeles County among gay and bi­sex­ual men who are not home­less. And an LAPD of­fi­cer who works on skid row was re­cently in­fected with the virus.

As a re­sult, county of­fi­cials have called for first re­spon­ders, mem­bers of law en­force­ment work­ing in the field and men who have sex with men — as well as home­less peo­ple — to get vac­ci­nated against hep­ati­tis A.

“We’ve got to be there with those that we’re ask­ing to help us deal with our home­less pop­u­la­tion,” said L.A. County Su­per­vi­sor Jan­ice Hahn. “We’ve got to be as con­cerned about their pub­lic safety as we are the safety of those who are sleep­ing on the streets. … This could be a huge pub­lic health cri­sis.”

Cal­i­for­nia de­clared a state of emer­gency last month be­cause of the out­break, which now ranks as the sec­ond­worst in the na­tion in more than two decades.

Hep­ati­tis A is com­monly trans­mit­ted through con­tam­i­nated food, but also can spread through sex­ual ac­tiv­ity or through con­tact with fe­ces, even in mi­cro­scopic amounts. The virus causes

liver dam­age and can be par­tic­u­larly harm­ful to peo­ple with con­di­tions such as hep­ati­tis B or C.

Cal­i­for­nia’s out­break is spread­ing from per­son to per­son.

L.A. County has seen 15 re­ported cases among those who are home­less or use recre­ational drugs since the out­break be­gan. But of­fi­cials say an un­re­lated hep­ati­tis A out­break af­fect­ing the LGBTQ com­mu­nity has sick­ened 14 gay or bi­sex­ual men this year, com­pared with nine last year and one the year be­fore.

“The sheer num­ber of cases … is what’s alarm­ing,” said Dr. Adam Co­hen, direc­tor of ad­vo­cacy and pol­icy re­search for the AIDS Health­care Foun­da­tion.

The uptick is par­tic­u­larly wor­ri­some be­cause there have been re­cent large hep­ati­tis A out­breaks among gay men in Colorado and New York, as well as in Chile and sev­eral coun­tries in Europe, said Dr. Prabhu Gounder, a med­i­cal epi­demi­ol­o­gist with L.A. County’s pub­lic health depart­ment.

“What we were con­cerned about is that we’re at the be­gin­ning of a sim­i­lar trend in L.A, and we wanted to get ahead of that,” Gounder said. Some in L.A. County who are in­fected had trav­eled to re­gions with out­breaks, he said.

The county health depart­ment is of­fer­ing free vac­cines at its clin­ics to gay and bi­sex­ual men.

Ear­lier this month, of­fi­cials in San Diego County ramped up ef­forts to vac­ci­nate gay and bi­sex­ual men. There have been 13 gay or bi­sex­ual men in­fected there this year, com­pared with one or two in a typ­i­cal year.

Gay and bi­sex­ual men gen­er­ally are at high risk for hep­ati­tis A and make up 10% of all new cases in the United States each year, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Dr. Takeshi Saito, a pro­fes­sor who stud­ies vi­ral hep­ati­tis at the USC Keck School of Medicine, said the hep­ati­tis A virus is highly con­ta­gious and can tol­er­ate ex­treme tem­per­a­tures.

Hep­ati­tis A has sur­vived in frozen berries and in­fected peo­ple who’ve eaten them. Even when some­one washes their hands with­out soap, they might re­duce the amount of the virus but won’t nec­es­sar­ily elim­i­nate it, Saito said.

The re­cently in­fected of­fi­cer, said Los Angeles Po­lice Pro­tec­tive League direc­tor Mark Cronin, is as­signed to the LAPD’s Cen­tral Di­vi­sion, which in­cludes down­town.

“Any­body that goes to Cen­tral Di­vi­sion drives through or walks through skid row ev­ery day,” he said.

On Tues­day, the L.A. County Board of Su­per­vi­sors ap­proved a mo­tion ask­ing the health depart­ment to make sure there was enough vac­cine to cover the first re­spon­ders most at risk of be­ing in­fected. About 18,000 doses of hep­ati­tis A vac­cine have been dis­trib­uted by the depart­ment, 3,500 of which have gone to first re­spon­ders.

“Our first re­spon­ders are our first point of con­tact with many of our home­less, es­pe­cially in the down­town skid row area, and it’s im­por­tant we pro­vide all re­sources avail­able,” Su­per­vi­sor Kathryn Barger said.

The county held a hep­ati­tis A vac­ci­na­tion clinic Wed­nes­day at Cen­tral Di­vi­sion, and more are sched­uled at other LAPD sites in the com­ing days.

LAPD spokesman Joshua Ruben­stein said med­i­cal pri­vacy laws pre­vented him from con­firm­ing that an of­fi­cer was in­fected with hep­ati­tis A, but he did say that the depart­ment “makes sig­nif­i­cant ef­forts to pro­tect … our of­fi­cers who

‘We’ve got to be there with those that we’re ask­ing to help us deal with our home­less pop­u­la­tion. … This could be a huge pub­lic health cri­sis.’

— Jan­ice Hahn, L.A. County Su­per­vi­sor

en­counter health and safety risks ev­ery day.”

Gounder said that the risk of ser­vice providers con­tract­ing hep­ati­tis A while work­ing is not high. Peo­ple who live or spend time down­town and don’t fall into the high-risk groups should not be con­cerned about hep­ati­tis A, he said.

“For the gen­eral com­mu­nity ... just by be­ing in the en­vi­ron­ment, we think the risk as­so­ci­ated with that is ex­tremely low,” Gounder said.

For those who are home­less and at high­est risk of con­tract­ing hep­ati­tis A, there’s a dire short­age of bath­rooms and wash sta­tions on skid row, said Amy Turk, pres­i­dent of the Los Angeles Cen­tral Providers Col­lab­o­ra­tive.

A re­port pro­duced by ac­tivists and ser­vice providers found that san­i­ta­tion con­di­tions on skid row fall be­low U.S. stan­dards for refugee camps, with nine pub­lic toi­lets avail­able overnight for the 1,800 peo­ple living on the streets.

“Most of the bath­rooms shut down at night,” Turk said. “Come night­time, folks have vir­tu­ally no op­tion but to use the streets.”

Ir­fan Khan Los Angeles Times

THE HOME­LESS are among those urged to get vac­ci­nated against hep­ati­tis A. Above, mo­bile show­ers serv­ing the home­less in L.A.

Hayne Pal­mour IV San Diego Union-Tri­bune

PEO­PLE fill out a form as they wait for hep­ati­tis A vac­ci­na­tions in San Diego last month. The out­break there has killed 20 peo­ple and sick­ened more than 600.

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