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San Diego Hepatitis A Outbreak Prompts City To Wash Streets, Sidewalks

City workers wash down streets and sidewalks in an effort to control Hepatitis A outbreak in San Diego, Sept. 11, 2017.
Susan Murphy
City workers wash down streets and sidewalks in an effort to control Hepatitis A outbreak in San Diego, Sept. 11, 2017.
San Diego Hepatitis A Outbreak Prompts City To Wash Streets, Sidewalks
San Diego Hepatitis A Outbreak Prompts City To Wash Streets, Sidewalks GUEST: Dr. Wilma Wooten, public health officer, San Diego County

This morning, the city of San Diego began sanitary Street washing downtown. The effort to wash various streets and sidewalks with a bleach solution is a move to stop the spread of hepatitis A among the homeless population. The number of diagnosed cases is topping 400 and the official death toll is effort is in response to a letter from the County saying the city streets had become legally contaminated environment. The city and County have been criticized for a slow response to the outbreak which began late last year. Joining me is Dr. Wilma Wooten, Dr. Wooten, welcome to the program. Thank you for having me. In addition to street cleaning, the county installed 40 handwashing stations. What other sanitary measures need to be taken to try to stop the outbreak? We are taking a 3-pronged approach to address is. Vaccination and sanitation and hygiene. Also education. We have implemented efforts through our field teams or field events going on to vaccinate individuals and work with the community partners to also help at to vaccinate individuals that are at risk and also have relationships to the at risk population, List -- specifically the homeless and illicit drug users. Sanitation, you described the city of San Diego, with their doing but we are also providing information to the municipalities where we have identified cases of hepatitis A and we are working with them to explore options in their jurisdiction as well. As we vaccinate individuals, we provide an incentive of hygiene kits to provide information to those that are vaccinated, including an education fact sheet as well as water and hand sanitizer and towelettes, the nonalcohol kind as well as plastic bags. People can use those if they need to. When they are in the encampments to use the bathroom. The county once the city do have a plan to address the hygiene issue. Does that include accessible public restrooms? That is an option that is on the table that the city has decided is an option but each jurisdiction determines what other options they will include to help address the issue. County officials declared a public health emergency about the hepatitis A outbreak. What does that allow the county to do ? It increases awareness. There is no specific binding that we are aware of. If the declaration can urge the state legislatures as well as local entities to identify additional funding, and even at the federal level, it could be useful for that purpose. But our primary purpose for issuing the health emergency was to increase awareness and to make everyone really be aware of the seriousness of this outbreak. Dr. Wooten, are other cities also experiencing and outbreak of hepatitis A ? It is across the county. The entire County Hassan outbreak. We have seen cases that have been in the city of San Diego but they are also in El Cajon and Oceanside and Escondido and national city. We are meeting with those municipalities to explore options that can be implemented in those areas. Last week, you were in the process of confirming one more death. Has that death been conferred ? We will issue our weekly update tomorrow and we will have information to share with the public at that time. County health, they realized there was something happening in March about the numbers of hepatitis A spiking. You started out with vaccination teams, I believe in June but why do you think it took that long to deploy the team's? Or to get the handwashing stations in place and the streets clean ? First of all, we have never utilized teams going out into the public. We do mass vaccinations and we start that early on. The foot teams were not -- the idea of using a foot team going out came up in our strategy and planning meetings. It is the same thing that goes for the handwashing stations. Again, identifying the strategies were and keep in mind, we cannot just go out and put handwashing stations out where we want. We started with the city of San Diego. We had to go through the process. We are doing the same thing with the other jurisdictions as well. Since the numbers of people coming down with hepatitis A are still going up, is it fair to say that the effort so far has not really been working ? No. That is not fair to say. Vaccinations are the most important thing that we can do to help curtail the outbreak. We have to vaccinate enough people so we can do that. That is what we do every day. We are vaccinating individuals so that we can turn this outbreak around. How long do you expect the numbers to keep going up before they level off and start to go down ? There is no specific answer that. The thing that we need to do, we need to vaccinate. We know there is a number of people that we need to vaccinate so we can get this and we are reevaluating what the number is. To date, we vaccinated over 20,000 individuals and we will continue to vaccinate those that are at risk, particularly individuals that are seen at service provider facilities for meals, homeless provider facilities as well as drug treatment facilities. I been speaking with Dr. Wooten, public health officer. Dr. Wooten, thank you. Thank you.

A San Diego Councilwoman called on the city Monday to take stronger measures along the San Diego River against an outbreak of hepatitis A that has killed at least 15 people and sickened around 400.

Councilwoman Lorie Zapf made her comments on the same day that city crews began washing down streets and sidewalks in an effort to control the disease. County health officials said about two-thirds of those who have fallen ill to hepatitis A are homeless and/or users of illicit drugs.

Zapf's district includes the beaches and the river mouth.


"This is an environmentally sensitive habitat for native animals and plants, and it's very worrisome that the staggering numbers of illegal encampments have overrun this very sensitive area, and it's an incubator for spreading the deadly disease," she said.

RELATED: Public Health Emergency Declared In San Diego County Over Hepatitis A Outbreak

She called on her colleagues to use their powers to help remove red tape and get the city to clean up the river bed.

"I went down there myself in July and what I saw with my own eyes was an insane amount of trash," Zapf said. "I saw human feces, meth cookers, syringes, stolen property — and all of this will flow right to the ocean if it is not cleaned up, and it will spread hepatitis A virus."

She said county health officials informed her that the virus can survive in the water for a few months.


The city cleanup efforts began in the East Village with the street and sidewalk spraying effort.

Disinfecting streets in affected areas is one of the measures demanded by county health officials in a letter to the city. The other primary step, setting up dozens of hand-washing stations, has already been carried out.

RELATED: Officials Fumbled With Permits, Pilot Project As Deadly Hepatitis Outbreak Surged

City crews removed belongings and debris from sidewalks and roadways to prepare for spraying with a formula that included bleach, according to broadcast reports.

The county, meanwhile, has been providing vaccinations to thousands of San Diegans, with 7,300 given to people considered to be at-risk of contracting the disease, which attacks the liver. Around 19,000 have been given out total.

Dr. Wilma Wooten, the county public health officer, said about two- thirds of the victims are homeless and/or users of illicit drugs. The hand- washing stations have been set up in areas where that population is prevalent, including downtown, Balboa Park and near the river.

She said she expects the number of victims to increase because hepatitis A has a long incubation period. The toll of fatalities is of confirmed cases - - an additional death is suspected of being from the disease but has not been confirmed by laboratory testing.