By: Marcus J. Hopkins, Blogger
As a blog designed to talk about issues related to Viral Hepatitis and HIV, we do our best to stay focused on the topic of Hepatitis C (HCV). Recent developments in San Diego, CA, however, have captured our attention and merit coverage and discussion.
Since early 2017, the Public Health Services Division (PHSD) in the San Diego Health and Human Services Agency (HHSA) has been investigating a significant outbreak of the Hepatitis A (HAV) virus. As of September 12, 2017, there have been 421 confirmed cases of Acute HAV which have resulted in 292 hospitalizations (69%) and 16 deaths (3.8%). The majority of these cases have been within San Diego’s homeless and/or illicit drug user populations, although some cases have been neither (HHSA, 2017).
HAV is spread primarily by ingesting the virus by way of contact with objects, food, or drinks contaminated by feces or stool from an infected person, and the symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and/or jaundice (yellowing of the skin or eyes). Moreover, HAV is very hardy and is able to live outside the human body for months, making it particularly easy to spread (CDC, 2016).
In response to this outbreak, San Diego has taken the unusually proactive step of implementing extreme health measures in order to combat the spread of HAV including the installation of 40 handwashing stations in areas with high concentrations of homeless people, sanitization efforts in those areas, holding 256 mass vaccination events and 109 “foot teams” of public health nurses who go into the aforementioned areas to offer vaccinations, distributing over 2,400 hygiene kits that include water, non-alcohol hand sanitizer, cleaning wipes, clinic location information, and plastic bags, and implementing street cleaning protocols that require sanitation department workers to power-wash streets and buildings with chlorine and bleach (Bever, 2017).
While these measures may seem extreme, the reality of combating an HAV outbreak once it’s already taken hold means that extraordinary steps must be taken. Despite the availability of HAV vaccinations since 1995, much of the homeless and indigent population either lack access to those healthcare resources, or are too old to have been vaccinated as children. During the mass vaccination events, county health officials have vaccinated 19,000 people, including 7,300 considered to be at-risk of contracting the disease (Warth, 2017). Additionally, the city has agreed to extend public toilet hours to 24/7 in order to allow homeless people access to the restrooms, rather than defecate in the open, whether others may come in contact (Montes, 2017).
While these proactive measures will certainly help to combat the spread, the most important step will be reaching, vaccinating, and educating hard-to-reach/hard-to-treat homeless, indigent, and/or illicit drug user populations in an effort to effect behavioral changes in order to prevent further spread of the disease. This means teaching proper handwashing techniques, proper hygiene, and proper sterilization of equipment used to partake in illicit drug use. San Diego, despite the dire circumstances it currently endures, is taking the right steps to ensure safer streets for their homeless population.
- Bever, L. (2017, September 13). To fight deadly hepatitis outbreak, San Diego begins power-washing streets with bleach. Washington, DC: The Washington Post: To Your Health. Retrieved from: https://www.washingtonpost.com/news/to-your-health/wp/2017/09/13/to-fight-deadly-hepatitis-outbreak-san-diego-begins-power-washing-streets-with-bleach/
- Centers for Disease Control and Prevention (CDC). (2016, October 03). Hepatitis A Questions and Answers for the Public. Atlanta, GA: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: https://www.cdc.gov/hepatitis/hav/afaq.htm
- Health and Human Services Agency. (2017, September 12). San Diego Hepatitis A Outbreak, 2017. San Diego, CA: San Diego County Government: Health and Human Services Agency: Public Health Services Division: Epidemiology. Retrieved from: http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html
- Montes, D. (2017, September 13). City washing: An outbreak of Hepatitis A threatens San Diego. Miami, FL: Pulse. Retrieved from: http://www.pulseheadlines.com/city-washing-an-outbreak-of-hepatitis-a-threatens-san-diego/67032/
- Warth, G. (2017, September 11). San Diego starts cleansing sidewalks, streets to combat hepatitis A. San Diego, CA: The San Diego Union-Tribune: News: Politics. Retrieved from: http://www.sandiegouniontribune.com/news/politics/sd-me-street-washing-hepatitis-20170911-story.html
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.