County begins vaccinating homeless residents after spike in hepatitis A cases

The San Diego County Public Health Department launched a hepatitis A vaccination campaign Monday at a local homeless shelter after detecting a recent spike in cases in the community.

Typically, two to three cases of severe hepatitis A infection are reported every month, but the county received notification of five cases from Jan. 10 to Feb. 6, said Dr. Seema Shah, medical director of the department of county epidemiology.

Although the rate is high, the cases do not yet meet the definition of an outbreak, the county said in a statement late Monday.

“The city is working closely with San Diego County to monitor the situation and facilitate vaccinations at our shelters,” Mayor Todd Gloria said in the county statement. “Over the past year and a half, our collaboration and early actions have prevented the spread of shigellosis and monkeypox, and we are taking the same proactive approach in this case to keep all San Diegans safe.”

Three of those cases, Shah said, involve homeless people, one of whom died. Little information about the death, such as gender, was available, even though the person was in their 40s.

Epidemiological investigations have so far not linked the cases, meaning they were not in close contact with each other. No sources of food, medicine or other shared items have been identified, Shah said.

Compared to the region’s last major hepatitis A outbreak, which began in 2016 and continued into 2018, the current number of cases is very low. During the first outbreak, an estimated 592 people were infected; 20 dead.

None of the five recently infected people have been vaccinated, and the county, as it did during the 2016-18 outbreak, is working to increase local vaccination rates.

“Exposed or not, vaccination is the best strategy to prevent infection,” Shah said. “That’s why we plan to make a big effort.”

Monday’s vaccination effort took place at a local homeless shelter “with one case identified,” according to the county statement. Fifty residents reportedly decided to get vaccinated on the spot, which the county has not publicly identified.

The hepatitis A vaccine became a universal recommendation for all children in 2006 and was available in some areas as early as 1996, meaning many young adults have already been vaccinated.

Physicians are advised to be on the lookout for symptoms of hepatitis A which, according to the US Centers for Disease Control and Prevention, include sudden onset of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice.

The disease usually lasts no longer than two months, although 10-15% of patients may experience recurrent symptoms for up to six months.

San Diego County recorded 31 serious cases of hepatitis A in 2022, many of which were caused by a nationwide outbreak associated with the consumption of organic strawberries.