What to Know
- A public health emergency was declared in San Diego County on September 1, 2017.
- Hepatitis A is most commonly spread person-to-person through the fecal-oral route.
- Hepatitis A can sometimes cause liver failure and even death.
One of the worst Hepatitis A outbreaks in San Diego County history is likely to continue for up to six months and lead to more victims, health experts said Tuesday. County and city officials also suggested not everyone needs to get a vaccine.
Since the outbreak was identified in early March, 16 people have died. Two other deaths are being investigated as possibly connected to the outbreak.
There have been 444 confirmed cases with an additional 44 cases that are considered suspicious. Officials said 305 people have been hospitalized for Hepatitis A virus. To compare, there were 181 cases in California in 2015 with just 22 in San Diego.
Given the incubation period of 15 to 50 days, health officials expect the outbreak to continue an additional six months.
"Based on history, prior to the availability of the vaccine in the late 1990s, we expect this outbreak will last longer, and will likely have an additional number of further cases," said Dr. Nick Yphantides, San Diego County's chief medical officer.
Most of the cases have been from downtown San Diego, El Cajon, Santee, La Mesa, and the adjacent unincorporated areas, county officials said.
"This is personal, this is our community, and we will protect it,” said San Diego Mayor Kevin Faulconer as he unveiled a new media campaign he called "Vaccination, Sanitation & Education."
Officials want the public to know not everyone needs a vaccine.
The following occupational groups must be vaccinated: fire, emergency, law enforcement personnel, food handlers, health care personnel and professionals, service workers working directly with the homeless population, and individuals working directly in substance abuse treatment programs, and public transit workers.
Information on upcoming changes to get the vaccine can be found by calling 211 or www.211SanDiego.org.
Since 2006, children have received the Hepatitis A vaccine in accordance with school immunization requirements.
Over 22,000 vaccinations have been performed by county health officials so far. Of these, 15,000 people were in a high-risk category, homeless, drug users.
The officials said 1,400 hygiene kits have been distributed, largely in the downtown area.
San Diego County Supervisor Ron Roberts said the first sign of something wrong was apparent in late February or early March. He said the county and city have been ramping up efforts to deal with an outbreak ever since.
Public nurses have been sent into areas of the county to reach transients and other people who may not have seen the warnings and alerts on local media, Roberts said.
“Vaccination and hygiene are the strongest things we can do,” Roberts said.
The most vulnerable are those living on the streets.
They’re most concerned for at-risk community – homeless, intravenous and illicit drug users, men who have sex with men, people who have sexual contact with someone who has the virus, people with a chronic liver disease, and individuals who have clotting factor disorders, Yphantides said.
Of the 444 confirmed Hepatitis A cases in San Diego County: 34 percent have occurred in individuals who are both homeless and IV or illicit drug users; 17 percent have occurred in individuals who are homeless only; 13 percent in individuals who are illicit or IV drug users only; 24 percent are neither homeless nor illicit drug users – but many of these cases have some relationship with individuals who are in an at-risk population; remaining 12 percent – no available records to classify accordingly.
Of the 16 deaths: officials had access to the personal history available on 15 of them. Those victims had underlying medical conditions, officials said. All but one was either homeless or/and an IV/illicit drug user.
The homeless outreach team with the City of San Diego and vaccination teams with the county have added public health nurses to administer the shots. They walk the river bed to vaccinate the homeless population living there.
"A big percentage of the people who have been victims of the Hepatitis A outbreak have been drug users or homeless people and we have both living along the river bed," said Sarah Hutmacher with San Diego River Park Foundation.
Workers and volunteers with the organization pick up trash along the river. They encounter everything, including human waste and needles, both of which can spread Hepatitis A.
"It's very, very common for us to encounter places where you find human waste, toilet paper, stuff like that," Hutmacher said.
The San Diego River stretches across areas like Santee, Mission Valley and then out to the ocean at Ocean Beach dog beach. The virus can live in standing water for months.
Of the 22,966 vaccines given by the county, 10,332 of those were given to at-risk population via field events, foot teams going out into at-risk remote places, mass vaccination clinics.
An additional 12,436 vaccines were given by community partners including clinics and pharmacies.
People who were known to have been exposed to the virus received the remaining 198 vaccines.
"We’re not recommending all adults get vaccinated for Hep A," said Yphantides.
He added that a member of the general population who is concerned has the right to pursue getting the vaccine from his or her own medical provider.
Dr. William Tseng with the San Diego County Medical Society said the prescription is simple - wash your hands.
"Remember what our moms used to tell us, what our teachers used to tell us – wash your hands," Tseng said. "Wash your hands. Say it 100 times, say it different ways."
The county sent out an alert to the public last week about possible contamination at World Famous restaurant in Pacific Beach. The restaurant has since been thoroughly cleaned.
Some diners, like Suzzette Haack, hope the news won't hurt business.
"It is not fair to the business. They don't deserve this or the reputation. They have a stellar reputation in the community," she said.
As of now, it is the only restaurant in the county with this warning.
The county will only notify the public if a person who handles food and drinks at a local restaurant tests positive for the virus. But managers, hostesses, and even dishwashers are not included.