State of Emergency: Largest Viral Hepatitis Outbreak Since the 1990s

The death toll from the California Hepatitis A outbreak has risen to 19 in San Diego, with more than 500 cases confirmed as a massive effort is underway to vaccinate as many as possible.

Last week, Gov. Jerry Brown declared a state of emergency due to a lack of the vaccine in several counties. The declaration allows the state to “increase its supply of hepatitis A vaccines in order to control the current outbreak,” a statement read.

Updated numbers in San Diego County alone show a total of 507 confirmed cases, with 19 deaths and 351 hospitalizations.

With last week’s total number of cases at 490, the latest reported increase to 507 may make it seem as if the outbreak continues to grow; but, because of the way that the public health department is tallying the outbreak, it is difficult to say whether that’s the case.

Last week, in a report to the San Diego County Board of Supervisors, Dr. Wilma Wooten, the county’s public health officer, said that her department had 47 cases under investigation. Those cases don’t get added to the outbreak totals until testing by the U.S. Centers for Disease Control and Prevention in Atlanta confirms that they were caused by the same strains of Hepatitis A that have caused other outbreak cases.

This is the largest outbreak of the disease since the vaccine became available more than 20 years ago.

Most of the cases are among the homeless or drug users, but there are several cases where people working at hospitals and health clinics have been affected.

Anyone working with people in those high-risk communities is urged to contact authorities and get vaccinated. The declaration also calls for food-service workers and shelter employees to get vaccinated.

More than 80,000 vaccines have already been distributed across the state this year; affected areas can now purchase additional vaccines from the federal government thanks to the state of emergency.

Since last November, San Diego health officials have distributed thousands of extra vaccines to those who are homeless and those who work closely with them, like healthcare providers. Cities in Orange County have started preemptively giving vaccinations to hundreds of other people who are homeless, even though there have only been only two reported cases there so far.

Meanwhile, as the crisis was unfolding, it turned out that there is nobody monitoring San Diego’s surface water for hepatitis A, where the homeless can set up encampments. Even a tiny particle of feces – when ingested – can infect someone.

The EPA responded last week, writing in a letter obtained by The San Diego Union-Tribune that the agency had reached out to area water researchers and determined no one was testing for the disease in San Diego’s surface water.

“It is clear municipal efforts must be broadened to reduce the many different sources of human fecal matter from homeless individual and group encampments in roadside rights-of-way, storm drains, beach parking lots and river bottoms,” a letter to Rep. Scott Peters from the EPA administrator read.

“People living in recreational vehicles can also be a source of illegal human waste dumping, lacking access to low-cost pump-out options. These sources of human fecal matter are confirmed in water-quality data submitted to the Regional Water Quality Control Boards along the Southern California coast.”