By Dr. Jennifer Sedillo,
Associate Professor of Public Health, American Public University and
RN and Master’s Student, Public Health
California is currently experiencing the largest person-to-person outbreak of hepatitis A in the United States since the hepatitis A vaccine became available in 1996, the Centers for Disease Control and Prevention reports.
California ranks first in the nation with 683 reported cases of hepatitis A and 21 deaths. The state has a 65% hospitalization rate.
Most Hepatitis A Cases Are Affecting the Homeless and Drug Users
Most of the cases “occurred primarily among persons who are homeless, persons who use injection and non-injection drugs, and their close direct contacts,” the CDC said.
In fact, recent cases of hepatitis A throughout the United States – especially in Michigan, Kentucky and Utah – have been unlike previous outbreaks in their severity and how the disease was spread.
Most often, hepatitis A is a vaccine-preventable viral disease found in contaminated food. For example, the CDC traced a 2016 hepatitis A outbreak to contaminated scallops and frozen strawberries. The disease is typically mild and rarely results in death, although the virus can cause liver failure and death.
San Diego County Has Seen the Worst Hepatitis A Outbreak in California
For some time, San Diego County has experienced the most cases of hepatitis A in California. The San Diego Public Health Department declared a state of emergency on September 1, 2017, following a large uptick in the number of cases.
In October, California Governor Jerry Brown also declared a state of emergency to assist in the purchase of hepatitis A vaccine. Brown’s declaration allowed the state to purchase the much-needed vaccine directly from the manufacturer.
As of January 3, 2018, there were 577 reported cases of hepatitis A throughout the county, including 20 deaths and 396 hospitalizations. Most of the deaths occurred among the homeless and drug-user populations.
Public health interventions have included mass vaccinations, sanitation and education. Healthcare workers have reached out to the homeless community, setting up field stations to vaccinate as many people as possible.
So far, more than 116,000 persons have been vaccinated and community centers have distributed more than 10,000 hygiene kits among the homeless population. Authorities say the so-called “herd immunity” among the homeless will likely stop the outbreak.
“Vaccinating people at risk of exposure is the most effective tool we have to prevent the spread of hepatitis A infection during an outbreak,” said Dr. Karen Smith, Director of the California Department of Public Health.
Other healthcare procedures include further education on disinfection procedures and regular hand washing.
The city of San Diego has taken an aggressive community-based approach to reduce the spread of the illness. It appears to be working as new cases are declining.
In addition, three large tents have been set up throughout the county as temporary shelters for the homeless and to stem the spread of hepatitis A. San Diego County has budgeted $80 million through 2020 to help permanently house the homeless. To date, the county has spent five percent of that amount on the hepatitis A outbreak.
About the Authors
Dr. Jennifer Sedillo is an associate professor of public health at APUS. She has held this position since receiving her doctorate in Public Health in 2014. Her expertise is in infectious disease research and microbiology.
Meghann Wilson is a registered nurse and a current MPH student at American Military University. She has served in the U. S. Navy for the past nine years and has a bachelor of science degree in nursing from the University of Wisconsin-Madison. Meghann is a Certified Emergency Nurse (CEN) and a Critical Care Registered Nurse (CCRN).