COUNTY BOOSTS EFFORTS TO PREVENT HEPATITIS
Cases on the rise, particularly among unsheltered population
With hepatitis A infections increasing among homeless people, the county health department is calling for greater vaccination and sanitation efforts throughout the San Diego region.
Generally averaging two cases per month, Dr. Wilma Wooten, the county’s public health director, said three cases were recently reported in the first week of May with four in the final week of April. Five of those most-recent seven cases were people who are homeless.
Calling this level of new infections “above baseline,” Wooten said she believes a more aggressive prevention effort is warranted to keep the disease from growing as it did during the region’s deadly hepatitis A outbreak in 2017.
“We don’t want the numbers to continue increasing, so we are going to use strategies to get in front of this,” Wooten said.
So far this year, Wooten said, 18 of 28 reported cases have been among the homeless population, a pattern that echoes the 2017 outbreak that sickened 592 people, causing 20 deaths.
Because the incubation time for the hepatitis A virus averages 28 days, current case totals are certainly incomplete, but it seems clear that the current increase in infections is not yet as large as was the case in 2017.
Week-by-week county records show that single-digit case totals that started increasing in February of that year hit 11 in a single seven-day span by late March with 19 recorded in the first week of May. Ultimately, the peak arrived in the time frame of Aug. 28 through Sept. 9, when health care providers reported 29 new infections to the public health department.
Public health officials first detected a slight increase in hepatitis A activity this past winter, call
ing for increased vaccination efforts that have already, the county said, resulted in 126 vaccination events, administering 4,500 doses to those considered most at risk of infection. A single dose is considered to be about 95 percent effective at preventing infection, with a second shot between six and 18 months causing immunity to last for decades.
Hepatitis A spreads through fecal contamination and can often cause nationwide outbreaks associated with specific foods that were harvested or processed in unsanitary conditions. The county health department has so far found no such commonly consumed foods among those infected, with the main commonality being homelessness and illicit drug use.
To combat the rising number of cases, the county recently increased the frequency of vaccination foot teams that circulate in homeless encampments from two to five days per week while continuing to offer additional vaccination clinics, including 18 more scheduled for the remainder of May. Additional countywide foot teams also distribute educational information on communicable diseases and hygiene kits.
Local doctors are being asked to make sure they check vaccination records for patients at the greatest risk of infection, offering doses to those who are unvaccinated.
Hepatitis A usually
causes symptoms such as nausea, stomach pain, fatigue and jaundice, which usually clear up within two months. But the virus sometimes causes deadly liver damage. This year, there has been one hepatitis A death in January. According to a recent communication with local doctors, 22 cases this year have been severe enough to require hospital
stays, and 14 of the cases reported have involved illicit drug use. Patients have ranged in age from 29 to 67.
Wooten said that there is no precise measure of exactly how many people still need to be vaccinated. But many, she added, require more than one encounter with an outreach worker before they’re willing to receive a dose.
“Sometimes you have to go back and talk to people several times before they consent,” Wooten said.
During the 2017 outbreak, vaccination alone did not get the spread of infection under control. Eventually, the county, working with cities, put handwashing stations and portable toilets in locations where homeless residents were
known to congregate. At one point, operating under a local emergency declaration, Wooten told the City of San Diego to begin washing streets and sidewalks in the most-congested areas.
That, she said, is likely to happen again. Wooten said she met with City of San Diego officials Monday to discuss street-cleaning efforts. A county official said Tuesday
that she directed the city to place 13 additional portable restrooms in downtown San Diego and to increase sidewalk cleansing, which is often done with water and bleach or other cleaners proven to kill the hepatitis A virus and other pathogens.
Rachel Laing, director of communications for the city, said in an email that San Diego was working out the details and timeline of complying with public health requests with contractors.
“City staff is currently working to add more bathrooms and handwashing stations and to increase the frequency of sidewalk sanitation, in accordance with the recommendation by County public health authorities,” Laing said. “We’ll continue to offer free vaccinations at our CARE coordinated outreach events and doing the outreach and education efforts that will help people get care more quickly and avoid the spread of communicable diseases.”
She said the majority of recent cases are “in unsheltered people living on the street.”
“It undersdcores why encampments are not safe for those living in them,” Laing said. “That’s why Mayor Gloria is supporting the Unsafe Camping Ordinance and other measures to put an end to street camping and create options for unsheltered people to get on a path to ending their homelessness.”