In September, Digital Journal reported that San Diego health officials were battling a Hepatitis A outbreak that had sickened 421 people and killed 16 between November 2016 and September this year. At the time, at least 279 people had been hospitalized.
In an update issued by the California Department of Public Health (CDPH) on Thursday, the Hepatitis A case count had risen to 600, with 395 people hospitalized and 19 deaths since November 2016, reports WTVR-Richmond.
With the number of Hepatitis A cases more than tripling, on October 13, Governor Jerry Brown declared a statewide “state of emergency.” By invoking a state of emergency status, California was allowed to purchase more vaccines, said Dr. Gil Chavez, state epidemiologist at California Department of Public Health. Since October 13, more than 80,000 vaccine doses have been delivered by the Centers for Disease Control and Prevention (CDC).
“We’ve seen hepatitis A from time to time, but it was very unusual seeing people so close together,” said Dr. Robert T. Schooley, an infectious disease doctor and vice chair of medicine at University of California at San Diego. And San Diego is where the majority of the cases are, with at least 500 of the 600 known Hepatitis A cases that have been identified.
The governor’s proclamation allows the CDPH to expedite the purchase of the vaccine and also allows EMTs to administer the vaccine outside the clinical setting. This is an important point because most of the victims are homeless and/or drug users who quite often don’t have access to public health centers or community clinics, said Dr. Wilma Wooten, director of public health services at the San Diego County Health and Human Services Agency.
San Diego, Santa Cruz, and Los Angeles have all declared local outbreaks, however, there are also additional outbreak-associated cases in other parts of the state. Disturbingly, the death rate is four times higher than average levels. Typically, the CDC records fewer than 3,000 cases of hepatitis A in the U.S. annually, so this outbreak is unprecedented.
Outbreak tied to homeless community and drug use
San Diego County has the unwanted distinction of being fourth behind Seattle, Los Angeles, and New York City in the number of homeless people living on its streets, with a total of 9,116 homeless people in San Diego City and San Diego County as of September 4, 2017.
Besides a large homeless population, the Hepatitis A outbreak has also been associated with the use of injection and non-injection drugs, according to the CDC. On August 25, 2017, CDC notified all state and local health departments about the investigation of a cluster of hepatitis A, genotype IB infections in California, asking other jurisdictions to report and cases.
On October 12, 2017, public health officials and the Michigan Department of Health and Human Services (MDHHS) said they are continuing to see an elevated number of hepatitis A cases in the City of Detroit, and counties of Macomb, Monroe, Oakland, Wayne, and St Clair. As of Oct. 12, Michigan has seen 397 Hepatitis A cases with 320 (85.6 percent) hospitalizations and 15 deaths.
And since January 1, 2017, Utah public health has identified 50 confirmed cases of hepatitis A infection; many among persons who are homeless and/or using illicit drugs. Several cases have been linked with viral sequencing to the national outbreak of hepatitis A involving cases in California and Arizona.
Utah officials have also noticed an increase in hospitalizations with this outbreak, however, they attribute it to many of the patients have underlying health problems, like alcoholism or higher rate of hepatitis comorbidities, such as hepatitis B or C. Most of Utah’s cases are tied to homelessness and drug use (48.8 percent) or just drug use 17.1 percent).
