With hepatitis A infections on the rise among homeless residents, the county health department is calling for greater vaccination and sanitation efforts across the region.
Typically averaging two cases a month, Dr. Wilma Wooten, county director of public health, said three cases were recently reported in the first week of May and four in the last week of April. Five of these last seven were 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 outbreak. deadly outbreak of hepatitis A in the region in 2017.
“We don’t want the numbers to keep going up, so we’re going to use strategies to deal with that,” Wooten said.
So far this year, Wooten said, 18 of the 28 reported cases have been among the homeless population, a trend that echoes the 2017 outbreak that sickened 592 people, causing 20 deaths.
Given that the incubation time for the hepatitis A virus averages 28 days, current case totals are certainly incomplete, but it seems clear that the current rise in infections is not yet as large as in 2017.
Week-by-week county records show the single-digit total number of cases that began rising in February this year hit 11 in a single seven-day period in late March, with 19 recorded in the first week of May. Ultimately, the peak came in the first week of August 28 to September 9, when healthcare providers reported 29 new infections to the public health department.
Public health officials first detected a slight increase in hepatitis A activity in the winter, calling for increased vaccination efforts that have already, according to the county, resulted in 126 vaccination events, administering 4 500 doses to those considered most at risk of infection. A single dose is considered to be around 95% effective in preventing infection, with a second injection between six and 18 months allowing immunity to last for decades.
Hepatitis A is spread through fecal contamination and can often cause nationwide outbreaks associated with specific foods that have been harvested or processed under unsanitary conditions. The county health department has so far found no such food consumed among infected people whose main commonality is homelessness and illicit drug use.
To combat the growing number of cases, the county recently increased the number of foot vaccination teams that circulate to homeless encampments two to five days a week while continuing to offer supplemental vaccination clinics, including 18 more planned for the rest of May. Additional countywide walking teams are also distributing communicable disease educational information and hygiene kits.
Local doctors are urged to ensure they check the vaccination records of patients most at risk of infection, offering doses to those who are not vaccinated.
Hepatitis A typically causes symptoms such as nausea, stomach pain, fatigue, and jaundice, which usually resolve within two months. But the virus sometimes causes fatal liver damage. This year, there was one death from hepatitis A in January. According to recent communication with local doctors, 22 cases this year have been severe enough to require hospital stays, and 14 of the reported cases have involved illicit drug use. The patients were between 29 and 67 years old.
Wooten said there is no precise measure of exactly how many people still need to be vaccinated. But many, she added, require more than one meeting with an outreach worker before they want to get a dose.
“Sometimes you have to go back and talk to people a few times before they consent,” Wooten said.
During the 2017 outbreak, vaccination alone failed to control the spread of infection. Eventually, the county, working with cities, set up handwashing stations and portable toilets in places 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.
This, she says, is likely to happen again. Wooten said she was meeting with San Diego city officials on Tuesday to discuss street cleaning efforts. Individual cities were also asked, she added, to indicate where portable toilets and handwashing stations could do the most good.
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