Hepatitis A shots being administered
Hepatitis A shots being administered in downtown San Diego during an outbreak in 2017. Courtesy City of San Diego

Once again, cases of Hepatitis A in San Diego County are on the rise with 28 reported to date and 18 among people experiencing homelessness.

The county usually reports about two virus cases monthly with one point reported in the homeless population last year.

While no single outbreak location has been identified, and no specific food or water source found, cases are being reported above baseline.

The county is doing its part to take steps to prevent more spread of the disease. The current increase in Hep A cases is a form of person-to-person transmission and not by food.

Public Health Services started a coordinated vaccination and education plan with area cities and organizations in early February after reaching three cases and one death in the homeless population.

Since then, more than 4,500 vaccinations have been administered to those considered most at-risk of the disease as efforts continue.

“We’re expanding ongoing efforts to reach the homeless community because this is a setting where cases could spread more quickly,” said Wilma Wooten, county public health officer. “We need all of our partners, from shelter operators, cities, and the healthcare systems, to join us in this response.”

Homeless individuals are considered more vulnerable to getting sick from the virus due to its ability to spread in places minus convenient access to bathrooms and handwashing.

Since February, 126 vaccination events have taken place. Another 18 are scheduled in May. Three outreach worker foot teams deployed twice a week have recently been expanded to five days a week and giving vaccinations, Hepatitis A education, and HARM Reduction Program resources, with a focus on encampments in downtown San Diego.

The effort is in addition to a regular county-wide foot team distributing information and hygiene kits.

The county also met in April with cities to discuss a fall 2022 sanitation survey and the cities’ plans. A report on the results was recently sent to all cities.

In a separate correspondence, all cities were asked to locate encampments and provide housing and/or more frequent cleaning along with handwashing stations and portable restrooms.

Outreach workers also are identifying locations where increased sanitation would be beneficial.

People experiencing homelessness often use hospital emergency departments to get treatment for health issues. As a result, County Public Health Services has issued an updated California Health Alert Network (CAHAN) to the healthcare community. The alert summarizes the increasing cases among people experiencing homelessness and illicit drug users and asks medical emergency departments and hospitals to vaccinate those at risk and screen for Hep A infections.

When a case is found, providers are asked to contact the county Epidemiology Program so an epidemiologist can interview the patient while in the medical setting.

Hepatitis A vaccination schedule is typically a two-dose series. The first dose of the Hepatitis A vaccine is around 95 percent effective. As this protection begins to decrease, a second shot is recommended at six months to 18 months later to provide immunity for between 20 and 40 years, according to the Centers for Disease Control and Prevention.

County Public Health Services updates Hepatitis A case and vaccination numbers online each Wednesday afternoon at sandiegocounty.gov/hepa. The website also has links to resources and other information. While there have been reports in 2023 of Hepatitis A cases tied to frozen strawberries, none have been confirmed in San Diego County. In the United States, five states report person-to-person Hep A outbreaks and an outbreak related to organic strawberries with cases in three states.