Paramedics are the newest troops in the fight against San Diego's ever-growing hepatitis A outbreak.
A letter signed this week by the director of the state Emergency Medical Services Authority temporarily expands state laws that govern paramedics, granting them emergency powers to "vaccinate at-risk populations in response to the outbreak."
Dr. Kristi Koenig, director of the San Diego County Emergency Medical Service, requested the temporary scope of practice expansion on Sept. 20 and said Wednesday night that she received approval in the mail Tuesday.
Paramedics will be able to deliver hepatitis A doses only under the supervision of nurses and only at special events created to inoculate those who are at high risk of infection, including homeless residents, drug users and those with liver disease or compromised immune systems.
Usually only nurses and doctors are allowed to give the vaccine.
“Paramedics already have basic skills in terms of delivering injections, and this approval allows us to give them extra training to do vaccination but only in very specific settings with very specific oversight,” Koenig said, adding that they will not be able to administer vaccines during emergency calls.
She said getting the state to approve the request took a fair bit of back-and-forth with California regulators. Assemblyman Todd Gloria, D-San Diego, added a letter of his own urging approval on Sept. 27.
Gloria said Wednesday evening that he believes paramedics can take pressure off public health nurses who have been engaged in a large and growing public vaccination campaign to stop the outbreak, which has now killed 17 people and sickened nearly 500 people throughout the region.
He said that these first responders can be effective with the homeless and drug-using population that has been disproportionately affected by the outbreak.
"Paramedics are often in communication with this population and, frankly, might be better able to get them to say yes to the vaccine," said Gloria, a former city council member. "This adds hundreds of health care professionals to the vaccination campaign. Having more boots on the ground, so to speak, I think can help us keep this outbreak from spreading any more than it already has."
The campaign, by all counts, continues to gain steam. Last week public health officials reported that more than 42,000 doses have been administered. During a presentation at the San Diego Convention Center Wednesday afternoon that number was bumped up to 54,000 by Dr. Eric McDonald, director of the county's Epidemiology and Immunization Services Branch.
He delivered that news to a room full of epidemiology experts attending the session of IDWeek, the annual scientific meeting of the Infectious Diseases Society of America which will gather at the San Diego Convention Center through Sunday.
McDonald and Dr. Monique Foster, a Centers for Disease Control epidemiologist who has worked with local health officials, noted that there has been a huge increase in hepatitis A cases nationwide recently. Over the last 15 months, Foster said, 1,400 cases have been confirmed, and genetic testing has shown that most of them are caused by a "1B" strain of the virus that is uncommon in the United States.
During her presentation at the convention center, Foster noted that hepatitis A outbreaks were known to flare every 10 to 15 years. Given that the current vaccine was not added to the nation's childhood vaccination schedule until 2006, the timing of the current surge in cases might be following that old pattern which regularly caused outbreaks with hundreds of cases before a vaccine was available.
"Maybe those cyclic increases still occur, and they're just blunted by the vaccine," Foster said.
Many in the audience at Wednesday's talk, who had traveled to San Diego from all over the nation, stood up and asked questions about the outbreak that just happened to be happening in the very city where their conference had already been scheduled.
One wanted to know more about the five health care workers who had become infected.
"Four of those five actually worked in direct patient care where there was a high flow of hepatitis A patients coming in," McDonald said, adding that a local physician in primary care is the most recent confirmed health care worker case.
Another wondered whether the majority of drug users who have been infected have favored crystal meth or intravenous drugs. McDonald said about half of the drug users were on meth while the rest got their fixes through syringes. That hasn’t been the case, he added, in other places where the outbreak has spread.
"In Santa Cruz (County) they're almost all IV drug users," McDonald said.
The physician also provided a few more details on the only child — a five-year-old — infected so far.
"It was an un-immunized member of a vaccine-resistant family who got it from a direct family contact," McDonald said.