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California's deadly hepatitis A outbreak could last years, official says

California’s outbreak of hepatitis A, already the nation’s second largest in the last 20 years, could continue for many more months, even years, health officials said Thursday.

At least 568 people have been infected and 17 have died of the virus since November in San Diego, Santa Cruz and Los Angeles counties, where local outbreaks have been declared.

Dr. Monique Foster, a medical epidemiologist with Division of Viral Hepatitis at the U.S. Centers for Disease Control and Prevention, told reporters Thursday 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.

Many are beginning to offer vaccines to their homeless populations, which are considered most at risk. Doctors know that people with hepatitis A — who may not even have symptoms — could travel and unknowingly infect people in a new region, creating more outbreaks.

San Diego, Santa Cruz and L.A.

San Diego County declared a public health emergency in September because of its hepatitis A outbreak. Since November, 481 people there have been infected, including 17 who died, according to the county’s health department.

Hep A in California

  • 481 cases in San Diego County
  • 70 cases in Santa Cruz County
  • 12 cases in L.A. County
  • 5 cases elsewhere in the state
  • Sources: county health depts, California public health depts

The only outbreak in the last 20 years bigger than California’s occurred in Pennsylvania in 2003, when more than 900 people were infected after eating contaminated green onions at a restaurant.

The hepatitis A virus, which causes liver damage, took root in San Diego’s homeless community. It is transmitted from feces to mouth, so unsanitary conditions make it more likely to spread. A common way for the virus to be transmitted is when an infected person uses the bathroom and doesn’t wash his hands, experts say.

San Diego’s outbreak then spread to Santa Cruz County, where 70 people have been infected so far, said county public health manager Jessica Randolph. There are typically one or two hepatitis A cases in the county each year.

Randolph said Santa Cruz County has distributed 1,381 doses of the vaccine so far, and plan to continue the effort.

It can take up to 50 days for an infected person to show symptoms, so more cases could appear, she said.

“I don’t think the worst is over,” Randolph said.

Health workers in Los Angeles are also trying to vaccinate the region’s massive homeless population after an outbreak was declared in the county last month. So far, 12 people have been infected, most of whom were either in San Diego or Santa Cruz when they were exposed.

A man passes behind a sign warning of an upcoming street cleaning along 17th Street in San Diego.
A man passes behind a sign warning of an upcoming street cleaning along 17th Street in San Diego. Gregory Bull / AP

Where next?

San Francisco health officials said Wednesday they were stepping up their vaccination efforts in light of the growing outbreaks statewide. So far, there have been 13 hepatitis A cases in the city, but none associated with the outbreak.

Tenderloin Health Services, a clinic in the San Francisco neighborhood known for its a large homeless population, has been offering hepatitis A vaccines to its patients for weeks. The clinic recently began holding special vaccination events and delivered 80 injections in three hours Friday, said Dr. Andrew Desruisseau, the clinic’s medical director.

“The cases in San Diego and the magnitude of the epidemic there certainly set off alarms in the Bay Area,” he said.

Desruisseau said 90% of the clinic’s patients are homeless and many also have other liver problems or are drug users, making the disease especially dangerous.

The typical mortality rate from hepatitis A is 1%, but the disease appears to have killed a higher rate of people in San Diego County because of the population it hit, many of whom already had weakened livers from hepatitis B or C.

All 17 people who have died in the San Diego outbreak had underlying health conditions, including 16 who had liver problems.

Desruisseau said he was concerned about conditions in the city that could help the spread the disease.

“With all of the housing crisis and gentrification in San Francisco, we’re seeing a much more condensed homeless population,” he said. “We have a lot of obstacles in keeping it a very sanitary place for our clients.”

Twitter: @skarlamangla


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