Hepatitis A shots being administered in downtown San Diego. Courtesy City of San Diego

San Diego County could have reduced the risk of the spread of hepatitis A last year with better organization and hastened vaccination efforts, according to a report released Thursday by state Auditor Elaine Howle.

According to the report, the county failed to set appropriate targets to vaccinate at-risk county residents and did not determine the level of resources such as nurses that would be needed to administer vaccinations.

While an average of 20 new hepatitis A cases were confirmed each week from May to mid-September 2017, vaccinations increased significantly by only September.

State Auditor’s report on San Diego Hepatitis A outbreak. (PDF)

According to the auditor’s report, vaccinations in September and October totaled more than 41,000, compared to about 7,700 in August. The spike in vaccinations led to a decrease in new cases, suggesting that the county could have limited the outbreak earlier in the year.

“The importance of immediate collaboration between the county, the city of San Diego and the state cannot be underscored enough,” said county Supervisor Kristin Gaspar. “I am optimistic that the state’s sudden interest in this matter will result in a much stronger partnership in the future. More important than pointing fingers and laying blame, is taking the lessons learned from this incident and using them to be better prepared for future health emergencies.”

The city and county of San Diego also failed to improve sanitation conditions in a timely manner, failing to increase access to hand-sanitizing stations and public restrooms until September 2017. According to the audit, such dysfunction was due to the county’s failure to inform the city of San Diego how severe the outbreak became.

“While I am still evaluating the extremely thorough report from the state auditor, one thing is clear: Lives could have been saved,” said Assemblyman Todd Gloria, D-San Diego. “We now know that the county and the city could have planned better and acted sooner to contain the spread of this disease. Unfortunately, that was not done until it was too late.”

Supervisor-Elect Nathan Fletcher said he welcomed the report because “it not only details what went wrong but most importantly provides clear recommendations moving forward. Lessons have to be learned.”

In a statement, Fletcher added: “Action has to be taken. We should never hesitate when it comes to taking action to tackle public health risks. I will work tirelessly to ensure all the recommendations are implemented. This report cannot be the last page of this story, it must be the start of a new chapter in ensuring a public health crisis like this never happens again.”

Howle’s office suggested multiple recommendations to the city and county to improve their responses to public health outbreaks. The auditor’s office advised the county to update its emergency operations plan by April 30, 2019, share relevant data with local jurisdictions and come to an agreement with the city of San Diego by March 31, 2019, to clarify how each entity should respond to future public health problems.

Howle’s office also advised the city to examine its actions during the outbreak prior to the emergency declaration on Sept. 1, 2017. The city was also urged to fix any weaknesses found during the review.

“We agree with the recommendations, particularly that the city and county should strengthen their relationship as it relates to responding to regional emergencies,” said city COO Kris Michell. “We look forward to working in partnership with the county on this recommendation.”

Updated at 4:35 p.m. Dec. 20, 2018

— City News Service

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