Hepatitis A Outbreak in San Diego Expands

San Diego county is experiencing an un-welcomed hepatitis A virus outbreak among its homeless and drug user population. There is no end in sight of this outbreak.

As of August 29, 2017, the San Diego County Health and Human Services Agency updated the total number of hepatitis A virus (HAV) cases:

• Reported cases: 378
• Hospitalizations:  263 (70%)
• Deaths:  15 (4%)

Additionally, three healthcare workers and four food handlers contracted HAV.

Public health investigators have not identified the source of the HAV outbreak. Most of the outbreak cases have been from the El Cajon/La Mesa area, and downtown San Diego.

“We are partnering with the community to ensure the people most at risk, particularly the homeless, have access to the hepatitis A vaccine,” said Wilma Wooten, M.D., M.P.H., County public health officer.  

“We’ve increased our outreach to vulnerable populations and have worked with organizations to host vaccination clinics and make information available,” said Dr. Wooten.

Hepatitis A can be spread through contaminated food or water, and can also be spread by sexual contact or sharing drugs with someone who is already infected.

Symptoms of hepatitis A virus include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools.

Symptoms usually appear over a number of days and last less than two months. However, some people can be ill for as long as six months.

The best way to prevent hepatitis A is by getting vaccinated.

The hepatitis A vaccine became available in 1995 and is recommended as part of the routine childhood vaccination schedule. However, many adults have not been vaccinated and may be susceptible to the hepatitis A virus.

There are three FDA approved monovalent hepatitis A vaccines:

• Vaqta (Merck) and Havrix (GlaxoSmithKline Beecham Biologicals), are approved for people ≥12 months of age in a 2-dose series
• A combined hepatitis A and hepatitis B Twinrix, (GlaxoSmithKline) vaccine is approved for people ≥18 years of age in the United States

Hepatitis A vaccines are routinely recommended for:

• All children: first dose of vaccine between 12 and 23 months of age, and the second dose 6 to 18 months later
• Travelers to countries that have higher rates of hepatitis A (high-risk areas include parts of Africa and Asia, and moderate risk areas include Central and South America, Eastern Europe, and parts of Asia)
• Men who have sex with men
• Users of injection and non-injection illegal drugs
• Homeless people
• Household or sexual contacts with hepatitis A patients
• People with chronic liver diseases, such as cirrhosis, hepatitis B or hepatitis C

For persons without health insurance, vaccines are available at County Public Health Centers. Most hepatitis A vaccines are available at doctors’ offices and pharmacies.

Persons planning an international trip should check the CDC Travelers’ Health website to see if the hepatitis A vaccination is recommended for their destinations.

The CDC Vaccine Price List provides current HAV vaccine contract prices and general information.