Nurse gives hepatitis A vaccine to homeless man
A San Diego County public health nurse gives a hepatitis A vaccination to a homeless man. Courtesy County News Center

The San Diego County Board of Supervisors voted Tuesday to end a state of emergency declaration over the hepatitis A outbreak in San Diego County amid a declining number of cases.

There have been no new reported cases of the illness over the last four weeks and the number of deaths linked to the disease has remained at 20 since late October. Those are two signs that the county’s three-pronged approach — vaccinating people who are at risk of contracting the disease, educating the public about prevention and sanitizing streets — has worked, health officials told the board.

“The outbreak activity has leveled off to near zero,” said Dr. Wilma Wooten, the county’s public health officer.

The number of hepatitis A cases reported in the region since November 2016 stands at 577. The period from last May to September averaged 84 cases per month. In contrast, there were seven cases last month and none in January, according to county data.

Experts at the U.S. Centers for Disease Control and Prevention support the decision to end the state of emergency in the county, Wooten said. The emergency declaration will remain in place at the state level, which will allow government agencies easier access to vaccines, she said.

Health officials stressed that lifting the emergency declaration doesn’t mean there’s no work to be done. “The new normal” means there could be a higher risk of contracting hepatitis A in the region, said Dr. Eric McDonald, deputy public health officer.

“These data show a steady decline in cases since the public health emergency was declared in September,” McDonald said. “Going forward, we expect to see a slightly higher number of hepatitis A cases in the county than before the outbreak.”

Vaccinations will continue at public health facilities, jails and shelters, and the county will hold vaccine clinics for those who handle food for work. Collaboration between the county and cities in the region will also continue and San Diego will keep sanitizing its streets, according to health officials.

Since the outbreak began, the county has distributed 119,157 vaccines, set up 160 hand-washing stations, given out 10,682 hygiene kits and delivered 188 presentations that have reached nearly 10,000 people.

The “three-pronged” approach is now being used as a model for hepatitis A response across the state by the DPH, county health officials said.

“We will remain vigilant and monitor the situation so we don’t have a resurgence of hepatitis A,” said Nick Macchione, director of the county Health and Human Services Agency.

While county officials were cautiously celebrating a job well done, several speakers at the meeting said the supervisors failed to act soon enough, pointing to several grand jury reports issued in recent years which found that government agencies needed to do more to address homelessness.

A 2010 report said homelessness in the county had “reached a tipping point” and found the lack of public toilets and the presence of human waste on streets posed a risk for the spread of disease. That grand jury recommended placing public toilets in downtown San Diego and sanitizing sidewalks in the area.

“Let’s be really direct here,” said former Assemblywoman Lori Saldana, who is running for the Fourth District supervisor position. “You chose not to act on those reports.”

Wooten on Aug. 31 directed the city to sanitize streets and sidewalks and expand access to restrooms and hand-washing facilities. The supervisors put in place the emergency declaration the next week.

The start of the outbreak can be traced back to November 2016. By early May, there were 80 cases reported and three deaths.

Supervisor Dianne Jacob said the county ought to study “what went right, what went wrong, if something did go wrong” now that the emergency declaration has been lifted.

Hepatitis A usually, which can be deadly, is transmitted by touching objects or eating food that someone with the virus has handled or by having sex with an infected person.

The disease doesn’t always cause symptoms, which can include fever, fatigue, nausea, loss of appetite, yellowing of the eyes, stomach pain, vomiting, dark urine, pale stools and diarrhea, according to the HHSA.

—City News Service