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Hepatitis A numbers increasing, particularly among homeless population

A paramedic with the San Diego Fire-Rescue Department prepares a hepatitis A vaccination shot in this undated photo.
Matt Hoffman / KPBS
A paramedic with the San Diego Fire-Rescue Department prepares a hepatitis A vaccination shot in this undated photo.

San Diego County continued to provide vaccinations to at-risk populations Tuesday as the number of cases of hepatitis A continues to increase, particularly among people experiencing homelessness.

A total of 28 cases have been recorded in the county so far this year, according to the county's most recent data. Of those, 18 are among people experiencing homelessness.

The county typically sees around two cases of the virus each month with only one case reported in the PEH population last year.


According to the county Health and Human Services Agency, no single outbreak location has been identified and no specific food or water source found. This current increase in hep A cases is a form of person-to-person transmission and not by food, the county reported.

"We're expanding ongoing efforts to reach the homeless community because this is a setting where cases could spread more quickly," said Dr. Wilma Wooten, county public health officer. "We need all of our partners, from shelter operators, cities and the healthcare systems, to join us in this response."

The county's Public Health Services began a vaccination and education plan in early February after reaching three cases and one death in the homeless population. Since that time, more than 4,500 vaccinations have been administered to those considered most at-risk from the disease as these efforts continue.

"Homeless individuals are more vulnerable to getting sick from the virus because of its ability to spread in areas without convenient access to bathrooms and handwashing," a statement from the county said.

Since February, 126 vaccination events have taken place. Another 18 are scheduled this month.


Officials are cautious about the illness, just a few years after a deadly outbreak of hepatitis A infected 592 people and killed 20 from late 2016 through October 2018. The following year, an audit by then-State Auditor Elaine Howle found that the county could have and should have "reduced the risk of the spread of hepatitis A last year with better organization and hastened vaccination efforts,"

Hepatitis A is usually transmitted by touching objects or eating food that someone with the virus has handled, or by having sex with an infected person. The disease doesn't always cause symptoms but can cause fever, fatigue, nausea, loss of appetite, yellowing of the eyes, stomach pain, vomiting, dark urine, pale stools and diarrhea, according to the HHSA.

The hepatitis A vaccination schedule is generally a two-dose series. The first dose is considered to be around 95% effective. Because this protection will eventually begin to decrease, a second shot is recommended at six months to 18 months later to provide immunity for between 20 and 40 years, according to the U.S. Centers for Disease Control and Prevention.

All cities in the county were asked by public health agencies to locate encampments and provide housing and/or more frequent cleaning along with handwashing stations and portable restrooms.

County Public Health Services issued a California Health Alert Network to the healthcare community summarizing the increasing cases among people experiencing homelessness and illicit drug users and asks medical emergency departments and hospitals to vaccinate those at risk and screen for hep A infections.

While there have been reports this year of hepatitis A cases tied to frozen strawberries, none have been confirmed in San Diego County. In the United States, five states report person-to-person hep A outbreaks and an outbreak related to organic strawberries with cases in three states.

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