San Diego’s ongoing hepatitis A outbreak has now killed 20 people in San Diego and, with the number of cases still on the rise, concern continues that the health emergency could reach new populations.
The county Health and Human Services Agency published new weekly totals Tuesday, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516.
Dr. Eric McDonald, chief of the county’s Epidemiology and Immunization Services Branch, said that the latest fatal case was a 67-year-old man who died on Oct. 26.
The man, McDonald said, was previously infected with hepatitis A but seemed to recover before symptoms returned. Like most of those who have died during the outbreak, the man had underlying liver problems. It was not clear Tuesday if he was homeless or an illicit drug user, the two populations most affected by the disease along with those who have contact with them.
Two Colorado hepatitis cases linked to San Diego
Relapse is a known occurrence with hepatitis A. Medical literature indicates that the virus comes back after appearing to be vanquished in between 3 percent and 20 percent of cases.
Though case totals are growing more slowly than they were over the summer, the county health department remains concerned that the outbreak could spread to gay men. Several outbreaks in this population are ongoing in Colorado, New York and Paris but are not connected to San Diego.
San Diego public health officials have noted that a large ongoing outbreak in Southeast Michigan, which had been largely contained to drug users, recently showed signs of an increase involving men who are badually active with men.
According to the Detroit Free Press, the Michigan outbreak generated 11 cases among gay men in October, compared with 10 in the preceding 14 months.
McDonald said that there has been no similar escalation in San Diego. So far, he said, 10 of the outbreak’s 536 confirmed cases have been among gay men.
“Right now we have no evidence of crossover to this community, but it is something that we’re continuing to do outreach on. It’s something that we want to prevent,” McDonald said. He added that the county is working with existing vaccination programs run by San Diego’s Family Health Services and The Center, a LGBT outreach nonprofit, to enhance vaccination efforts.
McDonald said the county’s recent efforts to vaccinate thousands of food service workers, first responders and others who have direct contact with the public are a big part of the effort to keep the outbreak from reaching a wider demographic group.
While there is concern about hepatitis A infections moving into new communities, there continue to be signs that the pace of new infections is slowing. In recent weeks the number of new cases reported to the county health department has been slower than it was in the summer and late spring.
“We were getting 20 to 25 confirmed cases per week, and now we’re down to half that,” McDonald said.
Last week, Dr. Wilma Wooten, the county’s public health officer, said that the outbreak had produced no new cases from Oct. 8 through Oct. 19. McDonald said that information was a “misstatement.”
To date, he said, there has not yet been a week without hepatitis A cases being reported to the county health department.
The hepatitis A virus spreads through fecal contamination.
While cases among the homeless and drug users have been getting most of the attention, there has been a steady increase in the number of local food handlers testing positive for hepatitis A infection.
On Sept. 15 the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive. The news sent hundreds to a special vaccination clinic to receive the hepatitis A vaccine which can help prevent infection if administered within two weeks of exposure.
At the time, seven food-service workers had been infected. Today, McDonald said, that number has increased to 17. The county has not notified the public of any other food service worker infections.
McDonald said the health department is following a notification protocol created by the U.S. Centers for Disease Control and Prevention. That protocol recommends public notice only if certain factors are present such as lack sanitation among workers and exposure within a time frame where administration of vaccine could help prevent infection.
“The other food handler cases did not meet the criteria that requires public notice,” McDonald said.
He added that the infected World Famous worker does not appear to have spread his or her infection to anyone else. The 50-day maximum incubation period for the hepatitis A virus has pbaded in that case. However, one of the other 16 food handler cases — one of those that the public has not been notified about — did cause a secondary case.
Currently, McDonald added, three food handlers who are hepatitis A positive are still within the 50-day window where secondary cases could appear.