What To Know About The Massive, Preventable Hepatitis A Outbreak In Southern California
Since last November, an outbreak of hepatitis A has caused 600 infections, 395 hospitalizations and 19 deaths across the state of California, according to the latest government statistics. The vast majority of those infections and hospitalizations and all of the deaths have occurred in San Diego, where the outbreak began. Here's what to know about this tragic, rare and totally preventable outbreak.
Hepatitis A Is A Rare, Acute Liver Disease That's Usually Not Fatal
Hepatitis A, a viral liver disease, isn't common in the US — there were about 2,500 cases nationwide in 2014. There's no cure for it once you've contracted it, but people usually recover on their own within a few months.
Hepatitis A is a virus that infects the liver and causes diarrhea, nausea, fever, loss of appetite, and fatigue. It can be fatal, and although most people make a full recovery, some end up with lifelong debilitations. There's a whole family of hepatitis viruses, since "hepatitis" just means "inflammation of the liver." The B and C forms are the most common and can become chronic, whereas type A is short-lived.
California's Governor Has Declared The Outbreak An Emergency
San Diego declared a health emergency in September. California Governor Jerry Brown declared a statewide emergency last week in an effort to make the vaccine more readily available to those in need.
Brown said the federally-funded supply of vaccines is inadequate. His proclamation allows the state to buy vaccines directly from manufacturers and distribute them…
California has distributed 81,000 federally-funded vaccine doses since the outbreak began and local jurisdictions have acquired more but the supply is insufficient…
Most Hepatitis A Outbreaks Are Spread Via Food, But This One Has Been Spread By Unsanitary Living Conditions
Hepatitis A is usually spread via food and can also be sexually transmitted. The last major outbreak of hepatitis A in the US was in 2003, when 935 people were infected after eating contaminated green onions at a restaurant. The Southern California outbreak, however, is being spread among the region's homeless population from person to person.
The virus is transmitted from feces to mouth, so unsanitary conditions make it more likely to spread. The city of San Diego has installed dozens of handwashing stations and begun cleaning streets with bleach-spiked water in recent weeks.
Many Homeless Advocates Blame Government For Creating Conditions That Spurred The Outbreak
San Diego County has the fourth-highest population of homeless people in the country, and local restrictions on public bathrooms have been blamed for enabling the disease to spread as quickly as it has.
In 2015, San Diego had just three city restroom facilities open round the clock, the San Diego County grand jury that investigates government operations reported. San Francisco had 25. San Diego had spent more than a decade trying to solve the problem, but funding difficulties, lack of support from businesses and concerns that additional facilities would attract more homeless people downtown have stood in the way, the grand jury noted.
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Tightly packed, informal encampments — which homeless people developed after they were kicked out of downtown — also made an outbreak more likely.
The hepatitis A outbreak now roiling this well-heeled, coastal city may have had its roots in a baseball game — when the city cleaned up for the 2016 All-Star Game by pushing its homeless out of the touristy areas downtown and into increasingly congested encampments and narrow freeway onramps just east of downtown. The lines of tents stretched for blocks.
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And California's ban on plastic bags may also have inadvertently contributed to the problem.
Some health officials speculate that one trigger of the outbreak might have been the state's plastic bag ban, which went into effect in November. What had once been a practice of last resort — defecating in a plastic bag and tossing it in the trash — is no longer an option. (The first recorded hepatitis A case occurred at the end of November.)
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The Fact That So Many Patients Are Homeless Has Made It Particularly Difficult To Control The Outbreak
Because homeless people are often transient, the disease could continue to spread beyond the currently affected counties as unwittingly infected people travel. (It can take up to 50 days for symptoms to show up in a person infected with hepatitis A.) And after long being ignored and mistreated by local authorities, many homeless people are hesitant to engage with public health officials.
"The normal method for preventing other people from getting sick gets thrown out the door when the community it's infecting lives outside," [public health advisor Oscar] Alleyne said. "You have to know where they went, who they came in contact with…. The likelihood of being able to capture everyone on that list is small." …
It's Possible But Not Confirmed That The Disease Is Being Spread By River Water
Some local officials think that the disease is being spread via a local river that contains a higher than usual amount of human waste.
In recent weeks some in the community have questioned whether the San Diego River may be a source of hepatitis A infection among the city's homeless. While county public health officials have insisted that river water is not a source of contamination, they told the Union-Tribune Thursday that river water has not yet been tested for contamination by one or more of the 15 unique strains of the virus that testing has found in samples gathered from infected residents.
A recent genetic test of river water, while it did not specifically check for hepatitis, did find that the total amount of human feces in the river and its tributaries quadrupled in 2017.
Public Health Officials Fear That The Outbreak Could Last Years
Because it's so difficult to identify and treat infected people, public health experts say that the outbreak may last quite a while longer.
Dr. Monique Foster, a medical epidemiologist with the Division of Viral Hepatitis at the U.S. Centers for Disease Control and Prevention, told reporters … that California's outbreak could linger even with the right prevention efforts.
"It's not unusual for them to last quite some time — usually over a year, one to two years," Foster said.
That forecast has worried health officials across the state, even in regions where there haven't yet been cases.
The Hepatitis A Vaccine Has Been Recommended For Children Since 2006
Hepatitis A has become rare in the US since the vaccine was added to the standard vaccination schedule for children 11 years ago. (The vaccine first became available in the mid-90s.) Public health officials are not currently recommending vaccinations for adults who don't belong to high-risk groups.
… prevention is key for hepatitis A, since the vaccine provides lifelong immunity. Data show since being added in 2006 to the recommended list of vaccinations for young children, the number of hepatitis A cases in the United States has decreased by 95%. Officials are instructed to control patients confirmed to have hepatitis A and quickly vaccinate those in immediate contact with infected individuals to increase the likelihood that the vaccine will be effective.