Health officials in California are struggling to contain fierce outbreaks of hepatitis A among homeless people and drug abusers in three counties, including San Diego, where at least 17 people have died.
Hundreds more have become ill and been hospitalized, mostly in the San Diego area, often not far from tourist destinations. The disease also has cropped up farther north in Los Angeles and Santa Cruz counties. Poor access to restrooms and sinks in homeless encampments is largely to blame.
Public health officials say the crisis has caught them off guard because it’s rare for the disease to spread so rampantly when it isn’t tied to a common source, such as a tainted food product. Meanwhile, as cases mount with no end in sight, critics fault authorities’ response as lethargic.
The California Department of Public Health says San Diego County’s is “the largest outbreak in the U.S. that is not related to a contaminated food product” since the U.S. first introduced a vaccine for hepatitis A in 1995.
“This is an unprecedented outbreak,” said Dr. Wilma Wooten, the county’s public health officer and director of Public Health Services for the San Diego County Health & Human Services Agency. “This is new territory.”
Wooten, who earlier this month declared a public health emergency, said about 65 percent of the 461 people known to have contracted the liver-attacking virus in San Diego County since last November through Tuesday are homeless and/or illicit drug users.
Under the direction of the county health department, the city is now power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution.
Earlier this month, the county installed about 40 portable hand-washing stations throughout the downtown areas hardest hit by the virus. Also this month, city officials announced plans to add restrooms to downtown areas.
And Los Angeles County announced that 10 cases had been identified among homeless people either on the streets or in shelters. Half of those patients had been to the San Diego or Santa Cruz areas, but at least two cases were locally acquired. In Santa Cruz County on the Northern California coast, about 70 people, mostly homeless or drug users, have been diagnosed since last April.
Hepatitis A is a highly contagious but typically mild illness and often does not require treatment. It does not cause chronic liver disease, as do hepatitis B and C, and is rarely fatal. But among those with existing liver disease and other illnesses common among the homeless, it can cause an acute liver infection and death. The best way to prevent hepatitis A is to get vaccinated, according to the federal Centers for Disease Control and Prevention.
Hepatitis A is usually spread when a person ingests fecal matter from an infected person — even in microscopic amounts, according to the CDC. That can happen when an infected person doesn’t wash his or her hands after defecating and then contaminates objects, food or water with which another person comes into contact.
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