What to Know
Twenty people died and 577 were sickened between Nov 2016 and Oct 2017 in the worst Hepatitis A outbreak recorded in the U.S. in years.
San Diego County health officials administered vaccines and distributed hygiene kits to combat the spread of the Hepatitis A virus in 2017.
A grand jury review also recommended improving communication between the county and the city in future health emergencies.
The slow response by San Diego County leaders to come up with a plan to administer vaccinations in the midst of a deadly Hepatitis A crisis may have contributed to the virus’ spread, according to an audit by the state of California.
It took the county and the city six months from when the Hepatitis A outbreak was first recognized in March 2017 to ramp up vaccination implementation and sanitization efforts, and only after a local state emergency was declared, according to the state audit.
The county "did not consistently set measurable targets and timeframes for administering vaccinations to the at-risk populations early in its response, nor did it determine the quantities of key resources—primarily, nursing staff—needed to carry out the vaccination program," the state auditor, Elaine M. Howle, wrote.
The audit also criticized the county's failure to create a group of leaders to coordinate response efforts. County leaders told auditors this would be implemented in the future.
The report, titled "By Acting More Quickly, the County and City of San Diego Might Have Reduced the Spread of Disease," did, however, praise the county’s efforts at identifying the populations at risk and the proper response efforts that should be implemented.
The state auditor recommended the county of San Diego should update its emergency plan by April 2019 and the city and county should revise a contract to clarify each jurisdiction's role in responding to public health matters.
Early on, city and county leaders appeared at odds with selecting the best methods to combat the crisis.
The city was not without fault, though, in its response to the outbreak. The state auditor noted in her report that the city should have taken additional steps to understand what needed to be done to halt the problem.
In one example, the state auditor said it took the city three months after discussing solutions with the county to install hand washing stations, opening more restrooms and sanitizing streets.
According to the audit, the city did not believe the outbreak was as serious as it was until a local emergency declaration from county public health officer Dr. Wilma Wooten in Aug. 2017, which was too late.
"If the city had had more information, it might have more quickly understood the need for the sanitation measures," the audit said.
Wooten did not implement an emergency declaration earlier because "the county wanted to work with the city first before it resorted to mandating compliance," according to the audit.
The outbreak, mainly affecting the at-risk homeless population and drug users, first began in November 2016 but was recognized in March of the following year, after a spike in Hepatitis A cases.
By the time San Diego's Hepatitis A outbreak was declared over in January, it was considered the worst outbreak in more than 20 years in the United States, according to Calif. Gov. Jerry Brown.
Cases in Colorado and Arizona were also linked to San Diego's Hepatitis A outbreak. At one point, the county warned restaurant workers that they may have been exposed.
In total, there were 584 cases of Hepatitis A reported during the outbreak in San Diego County. That included 398 hospitalizations and 20 deaths before county leaders ended the public health emergency in late January.
A county spokesperson said the findings in the state audit report were consistent with their findings released in an after-action report.
"The hepatitis A outbreak that occurred in San Diego County was unprecedented, and resulted in hundreds of illnesses and 20 deaths. Any event of this magnitude should be reviewed in hindsight. The County of San Diego appreciates the thorough review done by the independent State Auditors. The findings contained in the report prepared by the State Auditors are generally consistent with the County’s May 2018 Hepatitis A Outbreak After Action Report. Therefore, we want to reiterate our commitment to making the recommended improvements so that as a region we are better prepared to respond to any future health emergency."