Hepatitis A vaccinations: 100,000+ and counting

City of San Diego team up with American Medical Response and the Downtown San Diego Partnership to offer free hepatitis A vaccinations.

By Paul Sisson

San Diego Union-Tribune

Nov. 14, 2017 2:30 PM PT

With the number of new cases slowing and vaccination efforts hitting six digits, there were hopeful smiles all around Tuesday as local leaders received the latest data on San Diego’s deadly hepatitis A outbreak.

Officials with the county Health and Human Services Agency briefed county supervisors Tuesday morning, delivering the news that a massive vaccination effort underway since March has dispensed 100,147 doses, with 84 percent of those given to people, such as homeless residents and drug users, who are at the greatest risk of infection.

Dr. Eric McDonald, chief of the county’s Epidemiology and Immunization Services Branch, reported that in addition to reaching such a lofty vaccination milestone, there are immediate signs that the outbreak continues to decelerate.

Last week, he said, local health providers forwarded only eight possible hepatitis A cases to the health department for further investigation. There have been no new deaths, leaving the outbreak total at 20 for the second straight week.

It’s the lowest weekly new case total since the outbreak began, eventually launching a vast, multmilllion-dollar campaign to improve sanitation and housing conditions for the homeless.

“Unless there is a change in the epidemiology of the outbreak, it appears that we are past the peak of cases and things are clearly improving,” McDonald said.

What could still go wrong? The physician noted that the outbreak could still jump into another demographic population such as gay men who are considered at an elevated risk of hepatitis A infection. Because the virus’s incubation period can last up to 50 days, there is still a chance, he added, that an infected person could have exposed a large number of people who simply have not started to show symptoms yet.

While both McDonald and Dr. Wilma Wooten, the county’s public health officer, said the trend looks good, both stressed that vaccination is still an urgent recommendation for anyone who is in a high-risk group or who has a job that puts them in close contact with the public.

“We must remain vigilant and continue our vaccination, sanitation and education efforts,” Wooten said.

In addition to the homeless and drug users, high-risk groups are those with compromised immune systems, existing liver disease and gay men. Public-facing job classifications also recommended for vaccination include food handlers, first responders and health care workers.

As the outbreak continued through the summer months and into the fall, many have wondered about the 152 people, about 1 in 4 cases, who are neither homeless nor drug users. Tuesday was the first time that the county provided a fully-detailed accounting of these folks.

Seventy three of the people in this group had no known direct or indirect contact with someone with a hepatitis A infection.

The new weekly outbreak total now stands at 546 cases since November of 2016, which is just two more than last week.

That scant two-case jump, while it looks positively tiny compared to other weeks when it has increased by double digits, reflects the public health system’s byzantine accounting system more than the reality on the ground.

McDonald explained that nine cases were removed from the outbreak total because further investigation could not prove conclusively that they were connected. At the same time, 11 newly confirmed cases were added to the total, resulting in a net increase of two cases.

As of Tuesday, health officials added, there remain 32 cases under investigation, but most of those have been awaiting genetic test results for several weeks.

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