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

Two years after the hepatitis A outbreak that killed 20 and sickened nearly 600 started, San Diego County health officials finally declared an end to the outbreak.

Speaking to the San Diego Union-Tribune on Tuesday, county public health officer Dr. Wilma Wooten said Oct. 25 was 100th day since the last outbreak, meeting a threshold to declare the outbreak over.

So far in 2018, there have been only 15 confirmed cases, according to the U-T. At the height of the outbreak, the county averaged 84 cases per month.

The disease was first detected by county health authorities in February 2017. County epidemiologists first reported increased hepatitis A cases in March 2017, at which point nurses began regularly administering vaccines. The first cases likely occurred around the weekend of Nov. 22, 2016, officials said.

The county declared a state of emergency Sept. 1 as the disease continued to spread. Linked cases in Los Angeles and Santa Cruz counties led to a statewide emergency declaration in October.

The San Diego County action was terminated Jan. 23 when the number of cases ramped down following the installation of public toilets and sinks.

The outbreak disproportionately affected the county’s homeless population, partially because of lack of access to public sanitation facilities. The disease is transmitted by touching objects or eating food that someone with the virus has handled, or by having sex with an infected person.

As of April, the county had spent about $12.5 million responding the public health crisis.

The San Diego County After Action Report called the county’s early detection of the outbreak a success, as well as efforts to vaccinate individuals at high risk.

The county and city of San Diego have caught flak for their handling of the outbreak, however.

The San Diego Union-Tribune reported three people had already died by the time county officials started to dispatch street teams to offer vaccinations in May 2017. Street-team use quickly expanded after they proved their “effectiveness in reaching those hardest to access,” according to the county report.

One take away from the hepatitis A crisis is that it often took months for the at-risk homeless population to accept vaccination, Wooten told the U-T. They viewed it as a government conspiracy.

“But we knew it would take time for this population to trust us, and we had to just keep going back and engaging in order to build that trust,” she said.

Several other states continue to have outbreaks of hepatitis A, including Michigan where the latest reported cases were from October 2018. The outbreak there started in August 2016.

— Staff and wire reports

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