Hepatitis A Outbreak in California Leads to State of Emergency

Amidst the worst hepatitis A outbreak the state has ever seen, California’s Governor, Edmund G. Brown, Jr, declared a state of emergency on Friday, October 13, 2017. The declaration was made to help direct funds towards controlling the outbreak and providing adult hepatitis A vaccines to those in need.

The California Department of Health (CDPH) has already distributed almost 80,000 doses of the adult vaccine, according to the CDPH’s official press release on the declaration; however, more doses will be needed to appropriately respond to and control the outbreak. (Of note: the state has more than enough of the children’s vaccine.) According to the release, the declaration of a state of emergency enables the CDPH, “to immediately purchase additional vaccines directly from manufacturers and coordinate distribution to people at greatest risk in affected areas.”

CDPH Director and State Public Health Officer Karen Smith, MD, is quoted in the press release as stating, “Local public health officials are working hard to offer vaccines to people who are at the most at risk of infection, including homeless Californians. [The declaration of a state of emergency] will help ensure communities can continue to deliver the vaccines where they are needed most.”

This outbreak in San Diego began in March 2017 and is one of the 5 largest outbreaks that have occurred in the post-hepatitis A vaccine era. Almost 500 individuals have been affected, so far.

The United States has seen an increase in hepatitis A virus infections in the past 15 months, according to Monique Foster, MD, MPH, from the Division of Viral Hepatitis in the Centers for Disease Control and Prevention, who remarked in a presentation at the recent ID Week 2017 conference, in San Diego, that over 1400 outbreak cases have been reported to the CDC in this time period. “To put this into perspective,” she stated, “only 459 outbreak cases were reported in the 10 years between 2005 and 2015,” underscoring the severity of the current situation.”

Dr. Foster highlighted another unique aspect of these outbreaks is that the genotype of the virus is genotype 1B. The majority of the outbreaks seen in the past 5 years have been associated with this genotype of the virus.

Outbreaks of hepatitis A virus infections are associated with areas of poor sanitation and poor hygiene. The infection is spread via the fecal-oral route, by ingesting contaminated food or drink. In the absence of good sanitation, the virus can live for months on contaminated surfaces. According to the CDPH, in San Diego, “the current outbreak has largely impacted people experiencing homelessness and some illicit drug users,” a major problem in the area.

To this end, the San Diego County Health and Human Services has made major efforts to improve sanitation, such as installing handwashing stations in areas where high-risk individuals are known to congregate, updating street sanitation protocols, and distributing personal hygiene kits. As highlighted above, the department as also administered a mass vaccination campaign, with healthcare workers taking to the streets to administer the vaccine to those at risk.

With the declaration of the state of emergency and the multifaceted approach to prevention and treatment, the CDPH hopes to quell the outbreak and prevent further spread.