Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus.
Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego.
Ferrer said the department is ramping up prevention efforts locally so more people don't get sick. San Diego's outbreak has already spread to Santa Cruz, where 69 people have been diagnosed.
Officials say homeless people in California are most at risk, because the virus appears to be moving from person to person within that community. People become infected with hepatitis A, which affects the liver, by ingesting the feces of someone who's infected, often through contaminated food or sexual contact.
San Diego's outbreak appears to be fueled by poor sanitary conditions, with many cases among people who used shared restrooms in jails or shelters.
Ferrer said L.A. health workers will inspect homeless encampments in Los Angeles to improve sanitation, while spreading the word about improved hygiene. The city of Los Angeles is already cleaning the streets on skid row with bleach, a practice San Diego adopted earlier this month in an effort to reduce disease transmission.
She also said they're aiming to distribute 40,000 vaccinations of hepatitis A to homeless people in L.A. County. They're also providing shots to new jail inmates, active drug users and medical providers.
"We are very early in an outbreak and the more people who get vaccinated in the high-risk populations ... the smaller the outbreak will end up being in L.A. County," Ferrer said. "This is in fact a disease that's preventable."
The efforts will continue for months, she said, as San Diego officials expect their outbreak to persist into next year.
Los Angeles County health officials said that before this week, they had already counted eight patients infected with hepatitis A. Five had recently traveled to San Diego or Santa Cruz, where they were probably exposed, officials said. Three other people were infected at a healthcare facility where one of those five was being treated.
But Tuesday, officials said they had diagnosed two people who appear to have been infected locally, triggering the outbreak declaration. The two new cases involved homeless people who had not traveled to a place with an outbreak, Ferrer said.
"The outbreak label isn't meant to scare people," said County Supervisor Sheila Kuehl at Tuesday's county supervisors meeting. "It isn't suddenly that we're rife with hep A cases here."
Dr. Sharon Balter, L.A. County public health department's director of acute communicable disease control, said an outbreak of hepatitis A is the homeless community is especially concerning because many have underlying health conditions.
Most people recover from hepatitis A on their own, but it can be seriously harmful for people with other liver conditions, including hepatitis B or C. Approximately 4% of infected patients in San Diego have died, a significantly higher proportion than the typical 1% mortality rate for the disease, she said.
"This particular population is particularly vulnerable," Balter said.
Should you get vaccinated?
Though the current outbreak is centered in the homeless community, anyone can contract hepatitis A. Each year in L.A. County there are 40 to 60 people infected by the virus, which is often transmitted through contaminated food.
One of the 10 people in L.A. County infected in the ongoing outbreak worked at a fruit stand in Lancaster and may have passed on the virus. The only outbreak in the past 20 years in the United States bigger than San Diego's was caused by green onions served at a Pennsylvania restaurant that sickened more than 900 people.
It typically takes about three weeks to notice symptoms, which include vomiting, fever, yellowing of the eyes or skin, joint pain and dark urine. There's no specific treatment for hepatitis A, but for most people, symptoms usually don't last more than two months.
Health officials reminded people not to share food, drinks or cigarettes with people, and to wash their hands with soap after using the bathroom and before handling food.
Ferrer said people who are concerned about the outbreak should ask their doctor about the vaccine, which is already recommended for children.
"If you're older than 18 and you haven't been vaccinated, this might be a good time for you to get vaccinated," Ferrer said.
3:50 p.m.: This article was updated with background and additional details from the outbreak declaration.