California declares state of emergency over Hepatitis A outbreak as death toll rises to 19

Last Friday, the California Department of Public Health declared a statewide public emergency over the recent outbreak of Hepatitis A. The declaration will allow the state to purchase more vaccine doses directly from the manufacturers after hitting the limit on a special free vaccine program run by the US Centers for Disease Control and Prevention.

The outbreak has been centered in San Diego, though cases have been reported in Santa Cruz and Los Angeles counties as well as in San Francisco.

The death toll from San Diego’s ongoing outbreak reached 19 on Tuesday according to health department updates. Cases of the disease have shown a rise from 409 to 507 according to the county Health and Human Services Agency. The city’s substantial homeless population has suffered the brunt of the epidemic.

The county’s public health officer, Dr. Wilma Wooten, suggested that the outbreak might be slowing, noting that fewer new cases have been reported this week than the weekly total from a few months ago. She urged caution, however, saying that the long incubation period of the virus may mean the number of new cases could still surge over the course of the next few weeks.

“We have to be cautious. We know that this virus has an incubation period of 15 to 50 days, and we know that there are cases out there that just haven’t started to show symptoms yet,” Wooten told The San Diego Union-Tribune.

So far the county has been relying on mass vaccinations as well as the installation of hand-washing stations and portable toilets around the city in areas where homeless individuals congregate to combat the spread of the disease. Last week, the county reported that 68,500 Hepatitis A vaccinations had been given since March, when the outbreak was first reported.

Almost 100 hand-washing stations and portable toilets have been placed around the city, while contractors have power washed the streets with bleach in some areas.

The county did not say how much vaccine was on hand, but said there was enough to inoculate the most at-risk groups in the city, including the homeless, drug users, those with existing liver diseases, gay men, and those with weak immune systems.

Those who fall outside of these groups are advised to wait, due to the limited amount of vaccine available. “We are asking health providers to not vaccinate those individuals right now,” said Wooten, advising them to wait until the beginning of next year when more vaccine is expected to be available.

It is unclear by how much the nation’s supply of hepatitis A vaccine has been depleted, given that there are outbreaks in several states. The CDC has not said how much of the supply remains, citing “proprietary” issues. The CDC said it is in direct communication with the two manufacturers.

While the initial official response was to call for everyone to get a vaccination, now the strategy has shifted toward those most at risk, confounding prevention efforts. The county has sent more than 500 foot-team missions to areas where homeless individuals gather to administer shots, as well as shelters and other nonprofits that serve the homeless.

Volunteers, in addition to paramedics, will be granted temporary vaccination powers by the state after completing a four-hour training course before November.

Wooten told the Union-Tribune it would take about 80 percent of the at-risk population being immunized to create a “herd immunity” to prevent the disease from spreading. She said there were an estimated 125,000 intravenous drug users in the county and about 9,000 to 25,000 homeless people.

Hepatitis A is a disease spread though feces, either though swallowing contaminated food or in the presence of unsanitary conditions. The symptoms, including fever, fatigue, abdominal pain, and vomiting, can last up to two months. The disease can be fatal especially to those with liver conditions and can easily spread before any of the symptoms are apparent.

The virus is especially hard to kill and can live for months outside the body on objects and surfaces.

The cost of fighting the disease has been substantial. The county reports spending nearly $3 million since the outbreak began in March, mainly for public nurses to visit homeless camps and administer vaccines. The city council also approved up to $2.2 million in payouts to contractors who power wash the streets and stand guard outside newly installed public bathrooms.

The county predicts it will continue to have to spend at least $1.5 million a month to stop the spread of the diseases. While city officials have said they have enough funds to cover costs, some have pointed to the city’s $32 million budget deficit and are wondering if the county can pay.

As for the root causes of the outbreak, widespread homelessness and social decay, the city has brushed the problem out of public view.

Last month, the San Diego Police Department cleared hundreds of homeless tents out of the East Village near downtown. The homeless used to be tolerated there from 9 p.m. to 6 a.m., but now have been told they can never set up tents again.

The city has set up a campground with spaces for 200 tents in a city-owned parking lot near downtown. The facility, which does not even begin to solve the problem of homelessness in San Diego, will only be available for 60 to 90 days. It will close when the city opens three large industrial tents in December, each providing beds for up to 100 people. However, there are more than 9,000 people living in shelters or outdoors according to the latest homeless survey.