Hep C Discussion Forum

Cheddy · Moderator

Up-surge of Hep A in California

Tig · Admin

I saw that report yesterday and am stunned that this is so out of control. What part of this are the powers that be missing? Diseases that have been under control or nearly eradicated have been allowed to fester in many sectors of society. Now it’s affecting all sectors of society! Whether people are for or against vaccinations, it’s obvious that ignoring the areas and people affected by these diseases isn’t working. When they have to replace street cleaners with bleach trucks to wash away human excrement in our metropolitan areas, the problem has escalated to crisis proportions. Along with HAV, Measles, Mumps and Rubella are no longer considered eradicated. Why? Lack of vaccinations and cooperation between health agencies, individuals and homeless camps, among other things, is clearly a problem. This is a global problem and more has to be done to stop it. Ignoring it, obviously, isn’t going to make it go away or make it the least bit better. People and governments better start getting on the same page, or we‘re going to end up witnessing a repeat of historical plagues. Nice job... smh

Canuck · Guru

HELIO

IN THE JOURNALS

Hepatitis A outbreaks nearly 300% higher in recent years

Foster MA, et al. Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6818a2.

May 23, 2019

Reports of hepatitis A infections increased by nearly 300% in the U.S. between 2016 and 2018 compared with 2013 to 2015, primarily due to outbreaks associated with contaminated food items, men who have sex with men, and people who report drug use or homelessness, according to the CDC.

Monique A. Foster, MD, and colleagues from the National Center for HIV, Viral Hepatitis, STD, and TB Prevention at the CDC, wrote that hepatitis A outbreaks previously occurred every 10 to 15 years and were associated with asymptomatic children.

With the widespread adoption of universal childhood vaccination recommendations, asymptomatic children are no longer the main drivers of hepatitis A outbreaks, they wrote. Although the overall incidence rate of HAV infections has decreased within all age groups, a large population of susceptible, unvaccinated adults who were not infected by being exposed to the virus during childhood remain vulnerable to infection by contaminated foods ... and recently, on a much larger scale, through behaviors that increase risk for infection in certain vulnerable populations, such as drug use.

During the 2016 to 2018 period, the CDC tested 4,282 specimens. Of these, 91% had detectable HAV RNA, most of which were genotype IA.

The overall increase in reported hepatitis A cases was 294%, while Arkansas, Hawaii, Indiana, Kentucky, Missouri, Ohio, Tennessee, Utah, West Virginia, and Washing D.C. had an increase of approximately 500%.

While there is no universal vaccination recommendation for all adults in the U.S., the Advisory Committee on Immunization Practices recommends vaccination for adults who plan to travel to HAV-endemic countries, men who have sex with men, people who use drugs, people with chronic liver disease, and people experiencing homelessness.

Decreasing new infections from hepatitis A virus can be achieved and sustained by maintaining a high level of population immunity through vaccination, Foster and colleagues wrote. Continued efforts to increase hepatitis A vaccination coverage among the ACIP-recommended risk groups is vital to halting the current hepatitis A outbreaks and reducing overall hepatitis A incidence in the United States. by Talitha Bennett

Tig · Admin

Hep A is sadply reaching epidemic proportions. With the migrant crisis affecting multiple countries around the world, I see no reduction in cases at all. It’s more important than ever to have your immunity tested and be vaccinated against Hep A and B. If you haven’t made the decision to treat your Hep C, that should be first on your list.

Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness

Canuck · Guru

Further to my update/post (back on Oct 13, below) showing the numbers of hep A cases in other areas, I said ... "we also have to keep an eye on other states, for their outbreaks and numbers ... ie. Missouri, Tennessee, Arkansas, Ohio, and West Virginia to name a few" ...

Here are a few stats for a few of those States:

Nov 24, 2018 - Ohio - aprox 900 cases

Nov 2018 - Tennessee - aprox 449 cases, 279 hospitalizations, 1 death

Nov 19, 2018 - West Virginia - aprox 1859 cases, 960 hospitalizations, 5 deaths

Canuck · Guru

Further to this thread about hep A outbreaks in Calif (and Michigan, and Kentucky, Utah, Indiana, Missouri, Tennessee, Arkansas, Ohio, and West Virginia)!!!, I put here some more data from an article about these outbreaks in 2018 (their info covers up to about Oct 2018), as follows:

With immunization and effectively gaining control over hep A in the USA back in 1996, by aprox 2011 to recent times, the National average was down to about only about 1600 cases annually. With the recent US outbreaks in 2018 (up to about Oct) the National count upsurged to aprox 7000++, the count is covering over 12 US States. The numbers can REALLY be considered quite minimums as very certain count exclusions were made!

No longer just a foodborne, or out of county visit induced kind of disease - other local populations, pockets and pools of peoples are succumbing to exposure to and contracting hep a, homeless populations for one, increases seen not only in drug users, but where transient housing/economic instability and limited access to health care is seen.

Before 2017, most cases of hep A in the US had been seen to be genotype 1a, a type common to North and South America. In 2018 there was seen to be an increase in another, newer genotype 1b - they note the strain circulating in the Michigan area is a different type than what is being found circulating in Calif, Kentucky and Utah.

(As of Oct 2018), they noted a decrease in Calif cases, but that growth case numbers were still being watched especially in Kentucky, Michigan, Utah.

I wonder what effect the recent Calif fires may have on any further hep A outbreak potentials there.

I certainly hope these outbreaks stop!

Hoodietree · Senior Member

Thanks for the reminder cheddy, I need to get my hep A vaccine and double check my hep B vaccine status.

Cheddy · Moderator

A reminder: I had hep a antibodies when I was diagnosed. After treatment, they were gone and I had to repeat the A/B vaccine series, twice.

Next blood draw, find out what your own body says.

Tig · Admin

Biblical... smh

Canuck · Guru

Sheesh, hep c pandemics, hep a pandemics!

900,000 people in the US caught the flu last year (and 80,00 died of it!)

A typhus outbreak, currently headlining in L.A. for heavens sake!

Rat hep e, jumping over to humans in China. Legionnaires in a big box store!

Worries about keeping ebola contained. Cholera affecting so many poor people in the world ...

Brother! I'm glad i at least got my hep A&B and influenza shots! There is only so much one can do to try to hedge your bets in staying on the healthy side, and one of them is being immunized - it might just help (bigtime). C.

Canuck · Guru

Summertime stats below ... (I have just added "in red" the most up-to-date numbers i could find, along side the summer numbers) ... I only looked up a couple, for changes - the numbers are approximate, they could be larger numbers than shown here, and/or they could be leveling off/stagnating in some areas, or with new increases in new areas elsewhere:

__________________________________________________________________________________________________________________

So, somewhat more recent "summer time" reports are showing that the Hep A outbreaks in Calif and Michigan have slowed, but this was as other states were experiencing their upticks in these travelling/rotating Hep A epidemics - ya just never know where one of these scourges is going to start up or take off!

California tally in Aug 2018 - up to aprox 1221 cases total. (In April they were at about 704 cases with 21 deaths).

Michigan tally in Jul 2018 - up to aprox 865 cases total, 700 hospitalizations, 27 deaths total. (In April they were at 25 deaths). Oct 2018 - 899 cases total, 723 hospitalizations, 28 deaths.

Kentucky started off at about the 400 cases mark, at first, but then as of Jul 2018 they are at about 1094 cases, 687 hospitalizations and 8 deaths. After Aug 2018 - 1170 cases total (1400 in all possible, not confirmed), 881 hospitalizations, 12 deaths.

Utah fairly recently is at about 287 cases, 3 deaths.

Indiana fairly recently is at about 214 cases, 1 death.

But ... we also have to keep an eye on other states, for their outbreaks and numbers ... ie. Missouri, Tennesse, Arkansas, Ohio, and West Virginia to name a few.

Tig · Admin

Hi Hoodie,

It has become quite a serious problem in California. There are discussions here on the forum about that. Most of it in this thread. I will include a couple links that describe the seriousness of the outbreak. California is in line to beat the annual outbreak average across the entire country. This is one reason we encourage these vaccinations. Your risk of exposure goes way up when you’re in a high infection environment. Be cautious and wash your hands frequently in restrooms, restaurants, and public areas.

Hep A California

Hep A CDC

Hoodietree · Senior Member

Whoa. Thats an eye opener Canuck

How does one catch Hep A? Off to google...

-- Edited by Hoodietree on Monday 27th of August 2018 11:51:02 PM

-- Edited by Hoodietree on Monday 27th of August 2018 11:52:39 PM

Canuck · Guru

Agreed.

Dangerous, real dangerous for some.

I liked the article below "Patients with HBV, HCV should receive Hepatitis A vaccination" ... where the CDC highlights (that overall) our immunity to Hep A is from low to poor - that helps no one!

On an aside - been hearing on the news about our low protection against measles! A growing problem mostly in Europe right now! Sheesh, what next! I guess there is only so much a person can do to stay well. C.

-- Edited by Canuck on Tuesday 28th of August 2018 03:17:28 AM

Tig · Admin

Still way too high! Hep A is extremely contagious and even modest reductions can be thrown out the window overnight, unless comprehensive precautions are taken. Winter months, with freezing temperatures don’t even help, because the homeless (most affected) due to circumstances and conditions, tend to congregate together. That has been the most pressing problem in California this year.

Canuck · Guru

So, somewhat more recent "summer time" reports are showing that the Hep A outbreaks in Calif and Michigan have slowed, but this was as other states were experiencing their upticks in these travelling/rotating Hep A epidemics - ya just never know where one of these scurges is going to start up or take off!

California tally in Aug 2018 - up to aprox 1221 cases total. (In April they were at about 704 cases with 21 deaths).

Michigan tally in Jul 2018 - up to aprox 865 cases total, 700 hospitalizations, 27 deaths total. (In April they were at 25 deaths).

Kentucky started off at about the 400 cases mark, at first, but then as of Jul 2018 they are at about 1094 cases, 687 hospitalizations and 8 deaths.

Utah fairly recently is at about 287 cases, 3 deaths.

Indiana fairly recently is at about 214 cases, 1 death.

But ... we also have to keep an eye on other states, for their outbreaks and numbers ... ie. Missouri, Tennesse, Arkansas, Ohio, and West Virginia to name a few.

Canuck · Guru

Helio - News

Patients with HBV, HCV should receive hepatitis A vaccination

Moorman AC, et al. Gastroenterology. 2018;doi:10/1053.jgastro.2018.04.031.

May 9, 2018

Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a commentary published in Gastroenterology.

"Recent large outbreaks of HAV related to foodborne and person-to-person exposures have resulted in substantial rates of morbidity and mortality; these events underscored the relatively low prevalence of immunity against HAV infection among the U.S.-born adult population," Anne C. Moorman, MPH, from the CDC, and colleagues wrote.

According to Moorman and colleagues, the Advisory Committee on Immunization Practices approved language clarifying that all patients with HCV infection should receive HBV vaccination and physicians should consider HAV vaccinations for all patients with HBV and HCV infections.

The authors reviewed data from a variety of sources, including national survey and observational cohort data like the Chronic Hepatitis Cohort Study and the National Health and Nutrition Examination Survey. While HAV immunity among U.S. adults varied, the authors found that the rate of HAV protection among U.S. adults is overall poor, particularly for vulnerable populations with underlying chronic liver disease.

Specifically, 32.6% of patients with HBV and 33.6% of patients with HCV were never tested for HAV. Among those who had been tested, 58.9% of patients with HBV and 39.2% of those with HCV were anti-HAV positive. Additionally, 60.4% of patients with HBV and 62% of those with HCV who tested negative for anti-HAV never received follow-up vaccination.

"These findings, from multiple populations, support current guideline efforts to improve rates of screening for immunity to HAV and subsequent vaccination of vulnerable populations of patients with chronic viral hepatitis," Moorman and colleagues concluded. - by Talitha Bennett

Canuck · Guru

Helio - News

Hepatitis A cases spike among drug users, homeless

May 8, 2018

Since November 2017, Kentucky has seen a spike in reported hepatitis A cases, which has led to higher than average mortality rates among people with prior health conditions, including people who use drugs, according to the CDC.

"Although rare, hepatitis A can cause death in some people - such as people over 50 and people with other liver diseases," the CDC told Infectious Disease News.

Although the all-age mortality rate for hepatitis A is 0.6%, a higher burden has been observed among the homeless population and among those who use injection and noninjection drugs in the state.

According to the Kentucky Department for Public Health, there have been 448 cases of hepatitis A, with 315 hospitalizations and four deaths since November 2017. Some of the cases identified in Kentucky have been linked through viral sequencing to the outbreaks that occurred in California and Utah.

Indiana has also observed an increase in hepatitis A cases, particularly among injection drug users, since November 2017. Currently, Indiana has 91 reported hepatitis A cases, with 44 hospitalizations and no deaths. On average, the state observes approximately 20 hepatitis cases a year. Indiana health officials said the spike in hepatitis A cases in southern Indiana may be linked to the Louisville, Kentucky, outbreak.

Since 1995, the contagious liver infection has been a vaccine-preventable disease, and the national CDC hepatitis A guidelines recommend that children aged younger than 1 year, among other at-risk groups, receive the vaccination. However, the CDC has not issued a specific recommendation for hepatitis A vaccination among all adults living in Kentucky or Indiana.

"State and local health departments in the affected areas are prioritizing vaccination to individuals at highest risk of acquiring infection, including injection/noninjection drug users, men who have sex with men, persons in transient living conditions, recently incarcerated persons and individuals with chronic liver disease," the CDC told Infectious Disease News.

According to a press release issued by the Louisville Metro Office of Public Health and Wellness, a White Castle employee has been diagnosed with hepatitis A. Anyone who ate at the establishment located at 3701 Seventh St. Road in Louisville between April 6 and April 20, may have been exposed to the hepatitis A virus.

Working in conjunction with the University of Louisville Global Health Center, the Louisville Metro Office of Public Health and Wellness is providing vaccines to people who work in hospitality at a reduced cost of $25, according to the release.

"As soon as we became aware [of the hepatitis A exposure], we worked with the health department and did offer vaccines to all of our team members in the Louisville region," Jamie Richardson, vice president of White Castle told Infectious Disease News. "As a family-owned business, our number one priority is the safety of our team members and of our guests."

Canuck · Guru

Apr 11, 2018 update on Calif. hep A outbreak: 704 cases, 21 deaths. Only 4 new cases, no new deaths. Public Health has deemed a slow-down in this area and will not be routinely providing further updates.

Apr 25, 2018 update on Michigan hep A outbreak: 821 cases, 25 deaths. Up by 50 new cases, no new deaths.

California seemed the first to peak in the hep A outbreaks, and the first to slow, in relation to Michigans outbreak. But there are other outbreaks in other States going on as well, such as Kentucky, Utah, Indiana.

Canuck · Guru

More updates on Hep A outbreaks:

Michigan - Feb 28 update - 771 cases, 25 deaths. Up by 44 new cases, 1 new death. (Prior - 727 cases and 24 deaths).

Calif - Feb 23 update - 700 cases, 21 deaths. Up by 11 cases, no new deaths. (Prior - 689 cases and 21 deaths).

Calif seemed to peak sooner than Michigan, both Michigan and Calif. quieted some with winter. Waiting to see if there are again upsurges come Spring and Summer weather, with bodies mobilizing/migrating, and in consideration of the effectiveness of whatever steps/measures States/Counties and CDC have taken, to get a handle on these outbreaks.

Canuck · Guru

Hm, sorry. Looking back at the two links I pasted? (on Feb 1 and the next that said 2 days ago) ... I don't recall employing use of "word" to do that - I think I just copied and pasted the links directly from what I was "in and reading", but ... cannot be sure now - but don't think any use of "word" was involved?

Sometimes I think a cloud of computer glitch just follows me around like a malevolent ghost! My techno handicaps inconvenience me and those around me I am afraid.

Speaking of ghosts, in the Calif outbreak thing, they are speculating there has been a bit of a plateau, where as in the Michigan one (which you brought to my attention) it seems to be lagging a bit behind and is in the more peaking mode (there are a lot of contributory variables). Come spring, we may see the Calif one continuing perhaps at a lower more steady level? despite some good efforts to quell the spread. Michigan has been vaccinating like mad too, creatively and conveniently using the prison/detentions center systems there to innoculate at least about 4000+ people against Hep A. Hope all the states can do enough to knock this spread down as it seems to be a nasty variety of Hep A (all on it's own - jmo). The added negative influences the afflicted groups face (disadvantaged/lower socio-economic groups, those with prior hep/health issues, and just in general poor health/conditions anyway), is a perfect storm resulting in this awful loss of life and suffering!

-- Edited by Canuck on Sunday 4th of February 2018 01:39:05 AM

Tig · Admin

It was the info on 2/1 that was causing it to jump around on mobile devices. Did you clip and post or use Word to insert that bit of text? The forum software doesn’t compensate for the length or format of some additions like that. Word is a culprit sometimes. I usually find it and fix it, but sometimes it takes trial and error searching!

Canuck · Guru

Tig,

Nope, looks fine to me, dunt see nuttin funny, ie no scrolling or jumping on my end. Weird things eh? C.

Tig · Admin

Is anyone else having trouble viewing this thread? The page is auto scrolling (bouncing up and down)

Canuck · Guru

More updates on Hep A outbreaks:

Michigan - update from this week - 727 cases, 24 deaths. (Prior 658 cases and 22 deaths - up by 69 new cases, 2 new deaths).

Calif - update from last week - 689 cases, 21 deaths. (Up by 6 new cases).

Tig · Admin

It really looks like this unfortunate situation is gaining speed versus slowing down. I’m afraid people with chronic Hep B +/- C and let’s not forget HIV, that develop Hep A are going to really suffer significant illness and damage. I think it’s vital to get healthcare teams and mobile lab testing into these areas, in abundance!

We as a group have the loudest voices in this battle. Let your voice be heard, be it by phone or message, just do it. Our local governments need to know that this is important. Resources are provided to the squeakiest wheel. Remember there are far more people that don’t know they are infected with Hep C than do. The CDC says there is an annual number of 17,000 confirmed new HCV cases and because people don’t know, or their infections go unreported, the number may be closer to 30,000. Staggering....

Canuck · Guru

Tig found this, it can also be found over in HCV Advocate Monthly Report .

-- Edited by Tig on Saturday 3rd of February 2018 10:11:51 AM

Canuck · Guru

Update:

Overall numbers up somewhat (since last article of Oct 5).

Dec 29 - 21 deaths.

Hep A Outbreak/Immunization

Canuck · Guru

Update:

Hm, this news article is old (Oct 5, 2017), so, the numbers could be a bit "off", we can assume the numbers might be higher by now - I'll keep searching for a more "up-to-date" tally on the "small" Hep A epidemic in California.

Last news story (scroll down to Jul 25 post) the count was only (aprox) 275 people, and only 5 deaths, the outbreak confined to 2 areas.

The Oct article I post today, although not current, is still an interesting read, what with the experts "forecasts"/prognosis on this "outbreak". How long will it last, how far will it spread before it is finished. Note how almost ALL the deaths (up to 17 now) from this Hep A up-surge occured to the unfortunate folk who were already packing another kind of hepatitis! Just stands to reason, catching Hep A on top of having chronic Hep C, or on top of having chronic Hep B (or on top of being in any already liver-compromised state) can be fatal, just one too many insults (or hepatitises) for that persons poor liver and body to withstand.

Smaller clusters of Hep A have splintered off, now travelling? Total possible California cases 569 (at this Oct article date)? Most of these being in San Diego County, but about 90 of these cases showed up elsewhere, (in order of highest incidence) - Santa Cruz Country, L.A. County, and other unspecified places in California. It seems "most" of the more distant cases (non-San Diego), have been deemed to be related to/tracked back to the original San Diego outbreak.

A lot of immunizations have recently occurred in the hottest spots, good on public health - San Diego/Santa Cruz/Orange County, these spots and other places around are boning up and/or reviewing their prevention tactics, much talk on the Hep A topic is going on in places like Venice/San Francisco/ Oakland/ Sacramento/ Riverside.

http://www.latimes.com/local/california/la-me-ln-hepatitis-outbreaks-20171006-htmlstory.html

LamontCranston · Senior Member

Canuck wrote:
ya! eww. Oh well, I guess ya gotta do what you gotta doo. C.

Yeah, literally the whole town was 4 feet deep in water, and nothing like being at the mouth of a river, on a sand bar, with no power in a country that has no civil defense other than some 19 year kids with machine guns in the back of the Jefe's pickup truck.

When the sun went down on the 2nd day of the cat 4 storm, the wind was at 175 sustained with intense gusts that were spinning cars around and sailing palapa roofs like tiddley winks... then, hep A, cholera and well, time to go home!

Canuck · Guru

ya! eww. Oh well, I guess ya gotta do what you gotta doo. C.

Tig · Admin

"The culture of fecal coliforms from marijuana confiscated during one investigation (Alaska Department of Health and Social Services, unpublished data) raises the possibility that direct contamination of drugs could be a factor in some of these outbreaks."

OH MY!!!

LamontCranston · Senior Member

Hep A is the nastiest thing I have ever had the misfortune of acquiring. Getting "vaccinated" the old-fashioned way is Not Fun. I ran a

high fever for about 2.5 weeks, and was down for almost 6 months total. Nasty!

I got mine in Mexico during a hurricane, when the town I was living in flooded and well, you can imagine in a place that has no real sewage treatment. The Whole Dam Town was sick a few weeks later!

-- Edited by LamontCranston on Tuesday 25th of July 2017 08:05:27 PM

Canuck · Guru

Tig,

The article DID say ... this outbreak is different from most of the prior outbreaks because it is a result of person-to-person transmission and not caused by a contaminated product," the CDPH representative said. "The population affected are persons who are homeless and/or report drug use."...

(Very easily we could be seeing a group of people who are injecting/innoculating themselves with direct hits of hep A). By "blood" and/or by "association" could be possibilites ... here is an old article exerpt attesting to blood methods of hep A contraction.

... Two possible explanations for the association between hepatitis A and drug use have been proposed: 1) HAV may be transmitted by injection or ingestion** of contaminated drugs (common-source spread), or 2) transmission may result from direct person-to-person contact. The culture of fecal coliforms from marijuana confiscated during one investigation (Alaska Department of Health and Social Services, unpublished data) raises the possibility that direct contamination of drugs could be a factor in some of these outbreaks.*** Drugs could become contaminated with fecal material containing HAV at the cultivation site (e.g., through use of human feces as fertilizer) or during transport, preparation, or distribution (e.g., through smuggling in condoms concealed in the rectum (4) or in baby diapers). However, the pattern of occurrence of the cases by dates of onset in each of the outbreaks and the diversity of drugs involved argue against a single common-source mode of transmission. Nevertheless, sustained common-source transmission is possible if contaminated drugs were distributed among persons who then used them at different times.

Person-to-person transmission of HAV between drug abusers could result from sharing needles, from sexual contact, or from generally poor sanitary and personal hygiene conditions, which have often been observed among drug abusers. Isolated instances of bloodborne transmission resulting from transfusions from donors who had given blood during the incubation period of viral infection have been reported. Due to the relatively short viremic phase of HAV infection, however, bloodborne transmission through needle-sharing is unlikely to have sustained large outbreaks such as those reported here, although it may have accounted for one cluster in Cortland County ...

I only posted the first news article, merely, because it is always a good idea (and a reminder), for ANY person with an existing compromised liver status, (HCV or otherwise) to be immunized against other liver infections such a hep A or B (or even just the flu for that matter), if it could possibly prevent them from gaining even more trouble (on top of what liver troubles they already have).

Iris, I'm glad you posted here - I keep missing you, I see you post off and on, here and there, and I fret about you not being treated for your HCV. You SHOULD be immunized for A and B and flu. Not only that .... but please see my last post to you over in "Maybe not sick enough". smile C.

Iris Dragonfly · Guru

I didn't realize there was a hep A vaccine, and I have been reluctant to get the B vaccine. I wash my hands all the time in the last several years...to the point I feel obsessive compulsive, and that feels crazy to me. Yet I have had fewer colds and flu.

This is disturbing, being I live in Cali.

Bb, Iris

Tig · Admin

California has a huge migrant and homeless population. I'm curious what the breakdown in those numbers are. Sanitary conditions are generally responsible for HAV outbreaks. It's typically spread through food and water consumption of infected feces. Yum... doh I would be interested in knowing how many cases were distributed between agricultural and restaurant workers and customers.

The number of deaths and hospitalizations, not to mention the combined numbers of infections should really be worrying for state epidemiologists. This is one form of hepatitis that can really get out of hand quickly. (Obviously) HAV rarely results in hospital admissions, so that number alone is startling. It's usually a form of hepatitis that resolves on it's own, so these cases, again, are alarming. One infected individual can wreak havoc when sanitary precautions aren't instituted and followed.

Canuck · Guru

California health officials battle state's largest hepatitis A outbreak in 2 decades

Helio - July 21, 2017

The California Department of Public Health is working with local health officials in San Diego and Santa Cruz counties to contain the state's largest hepatitis A outbreak in 2 decades.

As of July 18, officials identified 251 cases and five deaths in San Diego, and 27 cases in Santa Cruz since the outbreak began in November, according to the California Department of Public Health (CDPH). San Diego's Health and Human Services Agency reported that 69% of cases in the county required hospitalization.

A CDPH representative told Infectious Disease Newsthat the overall case count is larger than that of all other hepatitis A outbreaks in California combined over the past 20 years. There were seven hepatitis A outbreaks in the state from 1998 to 2015, totaling 224 cases and one death.

"In addition to being the largest, this outbreak is different from most of the prior outbreaks because it is a result of person-to-person transmission and not caused by a contaminated product," the CDPH representative said. "The population affected are persons who are homeless and/or report drug use."

The CDPH said it will continue to provide technical assistance and hepatitis A vaccines to affected populations in San Diego and Santa Cruz.

"CDPH has issued statewide guidance regarding which groups of people to target for hepatitis A vaccination," the CDPH representative said. "The homeless/drug-using population is very difficult to access for vaccination, so this guidance has been shared with community health care providers and also with emergency rooms, jails and organizations that work with homeless persons and/or drug users."

The hepatitis A vaccine is routinely recommended for children, travelers to countries with higher rates of hepatitis A, homeless people, men who have sex with men, individuals with chronic liver diseases and household or sexual contacts of patients with hepatitis A. However, many adults have not been vaccinated against hepatitis A and are susceptible to infection, according to the San Diego health department. Because the outbreak largely affects homeless individuals and drug users, health officials recommend that unvaccinated workers and volunteers who interact with these populations be vaccinated. They are also urging people to practice good hygiene to avoid infection.

"It is imperative that anyone at risk for hepatitis A get vaccinated," Wilma Wooten, MD, MPH, San Diego County public health officer, said in a press release. "We cannot stress this enough: Get vaccinated and make sure you wash your hands after going to the bathroom. Lives are at risk. Protect yourself, your family and the community." - by Stephanie Viguers