2017 Hepatitis A Outbreak

Update: The Hepatitis A Outbreak in San Diego County Has Officially Ended

The County of San Diego has announced that the hepatitis A outbreak has officially ended. This conclusion is based on the fact that it has been 100 days (two incubation cycles) since the onset of illness of the last hepatitis A outbreak-associated case. Two incubation cycles with no new outbreak-related cases is generally considered sufficient time to declare the outbreak over. 

The hepatitis A outbreak resulted in 592 cases and 20 deaths. San Diego County officials identified the outbreak in March 2017. They were also able to later trace some cases back to November 2016. The County declared a local health emergency on September 1, 2017. This emergency ended on January 23, 2018. 

Vaccination events started in March 2017. Through October 3, 2018, more than 203,850 hepatitis A vaccines were given via healthcare providers and County vaccination events in response to the outbreak. 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.

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

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. 

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. 

Hepatitis A Vaccinations as of October 31, 2018

• Map: Hepatitis A Outbreak Vaccination Field Event Locations

Hygiene Kits

As part of prevention efforts, the County distributed hygiene kits (pictured right). These kits contained hand sanitizer, cleansing wipes, bottled water, an informational flyer, and a waste bag. Kits were provided to community partners that serve persons experiencing homelessness and users of illicit drugs who are at risk for hepatitis A infection and who have limited access to handwashing facilities. When distributed, community partners were encouraged to also recommend the hepatitis A vaccination.

Through October 31, 2018, 11,993 kits were distributed. 

Education

The County, along with Live Well San Diego partners, and other community organizations took several steps to educate the community about the hepatitis A virus. These include:

• A prevention outreach campaign started in mid-August in trolleys and bus stations in the City of San Diego.
• Numerous presentations by Health and Human Services Agency staff to local community partners, providing them with vaccine, sanitation, proper hand washing, and other important information on how to prevent getting and spreading the hepatitis A virus. 
• Developed and maintained a hepatitis A outbreak web page, containing the latest updates, resources, and educational information.
• Produced and distributed in the community a variety of printed materials, including flyers, fact sheets, posters, and disinfection and other guidelines.
• Produced news stories and articles for County News Center, County Television Network, and print and electronic media to keep the public informed about the hepatitis A outbreak.
• Contracted with 2-1-1 San Diego to help provide the public with hepatitis A virus information and resources.
• Foot Teams, consisting of public health nurses and other local healthcare providers, went out into the community to provide vaccines to at-risk persons.
• Issued several health alerts to local healthcare providers and public safety personnel through the California Health Alert Network (CAHAN) San Diego, informing them about the latest surveillance information, recommendations for providers, reporting requirements and other relevant details.