Hepatitis A Outbreak

Hepatitis A Outbreak in San Diego County is Officially Over

The County has announced that the hepatitis A outbreak which resulted in 592 cases and 20 deaths has officially ended. 

The conclusion is based on the fact that it has been 100 days since the onset of illness of the last outbreak-associated case, which is two incubation cycles for hepatitis A. Two incubation cycles with no new outbreak-related cases is generally considered sufficient time to declare the outbreak over. 

San Diego County officials identified the outbreak in March 2017, and were able to later trace some cases back to November 2016. The County declared a local health emergency on September 1, 2017, which ended on January 23, 2018. 

Vaccination events started in March 2017 and remain ongoing in order to prevent another outbreak. Through October 3, 2018, more than 203,850 hepatitis A vaccines have been given in response to the outbreak through healthcare providers and County vaccination events. Although one shot is enough to contain the outbreak, the County continues to work with partner organizations to identify and offer vaccinations for all recommended groups.

The response to the outbreak featured a number of new or untried strategies, such as sending ‘foot-teams’ of nurses with homeless outreach workers and law enforcement to give vaccinations to at-risk individuals where they were residing. The County worked with cities and provided sanitation protocols to clean areas frequently used by homeless, and deployed handwashing stations in public areas. 

Although the outbreak is over, County health officials anticipate travel-related hepatitis A cases to be reported. Typically, 2-3 cases are reported each month.

As part of the ongoing effort to prevent future outbreaks, the following persons are recommended to receive hepatitis A vaccine:

• People who are homeless.
• Users of illegal drugs.
• Men who have sex with men.
• People with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C. (They may not be at increased risk of getting hepatitis A, but are at increased risk of poor outcomes if infected.)
• Anyone who is concerned about hepatitis A virus exposure and wants to be immune. 

The vaccine is also recommended for the following individuals:

• Children are routinely vaccinated between their first and second birthdays (12 through 23 months of age).  Older children and adolescents can get the vaccine after 23 months. 
• People traveling to countries where hepatitis A is common. 
• Those being treated with clotting-factor concentrates. 
• Adults who have not been vaccinated previously and want to be protected against hepatitis A can also get the vaccine. 

For information about hepatitis A vaccine, individuals should call their healthcare provider or 2-1-1 to find a community clinic that provides the vaccine. 

Hygiene Kits

As part of its hepatitis A infection prevention efforts, the County of San Diego Health and Human Services Agency has hygiene kits available to help promote handwashing (pictured right). These kits contain hand sanitizer (as available), cleansing wipes, bottled water, an informational flyer, and a waste bag. The kits are being provided to community partners that serve homeless persons and illicit drug users who are at risk for hepatitis A infection and who have limited access to handwashing facilities. When distributing kits to clients, community partners are encouraged to also recommend the hepatitis A vaccination.