California's current person-to-person hepatitis A outbreak is the largest since the vaccines became available to the public in 1995. San Diego is the hardest-hit county in the state with over 500 cases so far.
Person-To-Person Hepatitis A Outbreak
California Governor Jerry Brown has already declared a state of emergency because of the state's battle with the hepatitis A outbreak, while San Diego, Los Angeles, and Santa Cruz have also declared a local outbreak status.
Laboratory testing shows that the current outbreak is caused by a hepatitis A (1B) strain that is not commonly seen in the United States but is common to Turkey, South Africa, and the Mediterranean region. The virus is spread from person-to-person and via fecally contaminated environments and is unrelated to contaminated food products.
So far, among the counties affected by the outbreak, San Diego remains the hardest hit, with 507 reported cases, 351 hospitalizations, and 19 deaths. Santa Cruz follows with 73 cases and then Los Angeles with 9. Eleven other cases have been reported from other California jurisdictions.
Challenges To Addressing The Outbreak
Reports state that a majority of the people affected by the outbreak are those who are homeless, are users of illegal drugs, or both, highlighting their lack of access to proper sanitary facilities and clean toilets.
That said, authorities are having difficulties in addressing the outbreak, as people who are homeless tend to be more difficult to offer the vaccines to. This is evidently due to their distrust of public health authorities, mental illness, and a lack of concern for the disease.
What's worrisome is that while the virus isn't a particularly virulent strain, people with underlying chronic liver disease are at risk of a more severe disease, especially since hepatitis A primarily affects the liver. Such is the case for the homeless and drug-using public who are said to often have liver conditions such as cirrhosis and hepatitis B or C.
What Are Authorities Doing?
Local health departments are tracking down all the contacts of every hepatitis A case reported and providing the affected individuals with a postexposure prophylaxis (PEP) to prevent them from getting infected. Similarly, the California Department of Public Health (CDPH) and the CDC continue to work with local authorities to provide enhanced surveillance, vaccinations, testing kits, and on-site staff among other things. Handwashing stations and clean toilets are also being provided for to help reduce transmission of the virus.
Last September, San Diego bleached the streets, ordered vaccination drives, and distributed informative flyers in an attempt to control the hepatitis A outbreak.
Unfortunately, despite the efforts on countywide and statewide scales, the CDPH believes that stopping the virus may still take more time.
