Los Angeles DPH Declares Local Hepatitis A Outbreak

As the hepatitis A outbreaks in San Diego and Santa Cruz rage on, another popular county in California is also getting hit by the virus: Los Angeles (LA).

In fact, last week, the Los Angeles County Department of Public Health (LADPH) declared a local hepatitis A virus (HAV) outbreak among homeless individuals and/or those using illicit drugs in the area. On September 19, 2017, the DPH identified 2 new cases of HAV infections in homeless residents of LA County, cases that appear to be locally-acquired, and thus not linked with any of the other ongoing outbreaks occurring in the state.

Eight other cases of HAV infections, however, have been linked to the other outbreaks. According to the LADPH, “These new cases indicate that spread may be occurring among homeless persons in LA County.” Officials also noted that infections appear to be occurring in individuals who provide services to the homeless as well.

“[The LADPH] has been proactively preparing for an outbreak for some time and is working diligently to prevent spread [in] local communities. Our priorities are to keep all our residents both safe and well-informed of the situation,” Jeffrey Gunzenhauser, MD, MPH, interim health officer, Los Angeles County, shared in the official press release.

The most recent case count for the outbreak in Santa Cruz is 69, which is outstanding considering the county only typically sees 1 to 2 cases per year, according to the Public Health Division in the County of Santa Cruz. The source of the outbreak has yet to be identified by officials. This and the long incubation period of the infection, which ranges from 15 to 50 days, is making their investigation more challenging.

Meanwhile, in San Diego, the Public Health Services Division of the San Diego Health and Human Services Agency has reported a staggering 444 individuals with confirmed HAV infection; the virus has already claimed 16 lives and landed the majority of infected individuals (305) in the hospital. Again, health officials are having trouble identifying a common source of the outbreak, and thus, the investigation is ongoing.

Hepatitis A is commonly spread via person-to-person contact if an individual comes into contact with another infected individual’s feces by ingesting contaminated food or touching contaminated objects. It can also be spread through certain sexual practices and by sharing injection drug materials. The homeless population is at increased risk of infection because of the challenge of “maintaining good hygiene,” according to the press release.

The LADPH shared several ways individuals can actively work to protect themselves against infection, including:

• Avoiding sexual intercourse with someone with infected with HAV
• Not sharing towels, toothbrushes, or eating utensils with anyone
• Not sharing food, drinks, or cigarettes
• Remembering to wash your hands with soap and water before preparing any food and after using the bathroom or changing diapers

One of the strongest ways for individuals to protect themselves against infection, however, lies in vaccination.

“Vaccination is the best protection against hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals,” Dr. Gunzenhauser said in the press release. Residents can call the LA County Information line at 2-1-1 to receive referrals to healthcare providers who are offering HAV vaccination for free or at a reduced cost.

The LADPH shared that they will continue to work with providers and organizations that work closely with the homeless population in order to offer better protection for patients, staff, and the community. In addition, they are also channeling their efforts into promoting awareness and education about the virus, so that physicians know to look out for associated symptoms and residents seek medical care if needed.