Three counties in Southern California are dealing with a hepatitis A outbreak, with the majority of cases afflicting homeless people, drug addicts and the people who provide services for them. “Public Health has been proactively preparing for an outbreak for some time and is working diligently to prevent spread in local communities. Our priorities are to keep all our residents both safe and well informed of the situation,” Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County, said in a media release this week. “Vaccination is the best protection against Hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals,” Gunzenhauser said. Hepatitis A outbreaks are also ongoing in San Diego and Santa Cruz counties. Officials have confirmed 10 total cases of the highly contagious virus among high-risk people in Los Angeles County. Four of the infected people had been in San Diego and one had been in Santa Cruz during their exposure period. Three secondary cases occurred in a healthcare facility in Los Angeles County. Two most-recent cases appear to have acquired their infection locally within Los Angeles County, officials said. Hepatitis A can be acquired through contact with an infected person’s feces through contaminated food or objects. Officials have all but ruled out contaminated food as the source of this outbreak. The hepatitis A virus can spread when a person does not properly wash their hands after going to the bathroom or changing diapers. The virus can cause acute liver disease. Other modes of transmission include certain sexual practices, sharing equipment related to illicit drug use, and consumption of food or water contaminated with the virus. People who are homeless are at higher risk because they face challenges to maintaining good hygiene, officials said. Symptoms of acute hepatitis A include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than two months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination or administration of immune globulin within two-weeks following exposure. San Diego County Public health officials in San Diego County have been grappling for several months with the outbreak of hepatitis A, which is blamed for at least eight deaths, with all of the victims weakened by underlying medical conditions. Nick Yphantides, MD, with the San Diego County Health & Human Services Agency, said this week that “the outbreak is not from a contaminated food source. It is caused by person-to-person transmission.” “One of the challenges of this virus is the long incubation period,” Yphantides said. “With this virus the average incubation period is 28 days, but the range of the incubation period can be anywhere from 15 to 50 days, which is quite a long incubation period.” “Another complicating factor, medically speaking, is that individuals can be infected and can be transmitting the virus for up to two weeks prior to them having any symptoms,” he said. Santa Cruz County Since April, Santa Cruz County has had 69 confirmed cases of hepatitis A. They usually have 1-2 confirmed cases per year. The county’s Public Health Division says an investigation is ongoing and challenging because of the long incubation period and the difficulty contacting people sickened with the illness who are homeless and/or illicit drug users. With no common source of food, beverage, or other cause identified, the source of the outbreak remains undetermined, county officials said.
Vaccinations are urged, but the source of the outbreak is still unknown, as public health agencies in Los Angeles, Santa Cruz and San Diego counties take measures to combat the highly contagious virus.