Hepatitis A outbreak continues to simmer in North County

Four new cases show that, while it's not as bad as it was in 2017, San Diego County's hepatitis A outbreak is not yet extinguished.

Weekly public health reports this week and last have each added a pair of newly-confirmed cases to the outbreak total. Although that's nowhere near the number of new cases that flooded in every week in August and September, it's still a faster pace than the roughly every-other-week frequency that government records show San Diego County averaged before from 2012 through 2016.

"The outbreak is not over, and the most recent cases seem to be slightly geographically skewed to the northern part of the county," said Dr. Eric McDonald, chief of the county's Epidemiology and Immunization Services Branch.

Largely spread among the region's homeless population, that has not necessarily been the key demographic characteristic of the latest outbreak-connected hepatitis A cases. McDonald said three of the four cases were drug users but only one of those was homeless. The fourth was a family member of a person who was already known to have an active hepatitis A infection.

"The individual was advised to get vaccinated to prevent illness, but chose not to do so. Most people get vaccinated promptly when we advise it," McDonald said.

He added that two of the four cases were evenly split among coastal and inland North County, but the zip codes where each case occurred were not immediately available.

To date, the outbreak has generated 582 cases. The viral liver infection has hospitalized nearly 400 people since November 2016 and has killed 20. Hepatitis A, which spreads through fecal contamination, is not usually fatal unless a patient has other co-occurring illnesses such as immune system deficiencies or other liver diseases, including hepatitis B and hepatitis C.

Desperate to end the outbreak's rapid spread, San Diego County officials declared a local health emergency on Sept. 1, 2017, canceling the directive on Jan. 23 once it appeared that the crisis was under control.

McDonald said outreach efforts are continuing in coastal and inland North County with vaccination foot teams working to deliver doses to homeless residents. Shelters and substance abuse treatment centers are also being asked to make sure their clients have been immunized.

Oceanside reported that it will continue to maintain four hand-washing stations in the community through March 1. The city also continues to clean its public facilities, including parks and public restrooms, with a diluted bleach solution recommended by the health department.

The City of Encinitas continues to maintain several portable toilets in public locations including the lower parking lot of Encinitas City Hall, the Encinitas Community and Senior Center, Moonlight Beach, Swami's Beach, Beacon's Beach, and near Leucadia Roadside Park.

The City of Escondido never set up any hand-washing stations or public toilets during the outbreak, but Interfaith Community Services, which is based in the city and serves many homeless in inland North County, does offer sanitation amenities at all of its facilities.

The county has 10 hand-washing stations in different North County locations and will continue their maintenance through the end of March, according to county spokesman Craig Sturak. There had been 250 vaccination events held in North County from Dec. 1, 2017 through Feb. 22 with 31 more scheduled through Mar. 31, Sturak added in an email.

Greg Anglea, the nonprofit's chief executive, said he had just finished attending a vaccination event at Interfaith's Escondido site Thursday.

"We've had a number of people come through and get the second hepatitis A shot just today," Anglea said.

He said that his organization remains focused on the bigger picture.

"The reason this spread so virulently is because of the conditions that homeless people have to live in, and those are as unacceptable today as they were before the outbreak," he said.

An ongoing fundraising effort with the goal of helping get 1,000 people off the streets permanently has surpassed 450 people seven months after it started. For more information on the campaign, visit interfaithservices.org/housing-1000 .

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