On October 13th, a state of emergency was declared by California Governor Jerry Brown in response to the hepatitis A outbreak that has been running rampant. With nearly 600 confirmed cases and 18 deaths already, the government cannot get enough vaccines. Health officials have already distributed over 81,000 vaccines for Hepatitis A but epidemiologists with the California Department of Public Health are expecting that number will be insufficient.

What is Hepatitis A?

Hepatitis A is an extremely contagious viral infection that affects the liver. Once the virus is contracted it causes inflammation to occur in the liver. Hepatitis A is contracted when even the tiniest amounts of fecal matter are ingested. It can also be contracted by contaminated drinking water, being in close contact with an infected person, and by having sex with someone infected. Hepatitis A symptoms generally don’t occur until you have had the virus for a few weeks, at which point you could develop any of the following symptoms:

  • Fatigue
  • Nausea and vomiting
  • Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
  • Clay-colored bowel movements
  • Loss of appetite
  • Low-grade fever
  • Dark urine
  • Joint pain
  • Yellowing of the skin and eyes (jaundice)

The difficult part with Hepatitis A is that many people could be carrying the viral infection and not even know it because they don’t have any symptoms. Hepatitis A can be fatal, as it has been for some in California, but most of the time people who receive proper treatment can expect to make a full recovery.

What is Being Done?

Experts overseeing the current outbreak in California are expecting that this outbreak could last more than a year. Officials are planning numerous interventions to help combat the infection. Besides vaccinating people, city officials have implemented power-washing streets and installed hand-washing stations. There are currently plan to open an encampment for the homeless equipped with tents, showers, restrooms, food security and social services. Given the nature of hepatitis and how it is spread these measures will surely help to prevent the spread of the infection.

High-risk Populations Being Infected

It appears that spread of Hepatitis A is almost exclusively among the homeless and drug-using population in California. This further complicates the efforts to treat and stop the spread of the infection. Drug users are at the highest risk for contracting hepatitis A, yet they statistically they have the lowest immunization rates. The hepatitis A vaccine became available in 1995. The CDC now recommends that all children get vaccinated but most adults have not been vaccinated as and doctors don’t push hepatitis A vaccinations due to the relatively low risk of contracting it.

Treatment Struggles

The homeless and drug-using population is a difficult population to care for. These populations are the highest risk population and often have the least access to health care. Even with adequate access, getting drug users and the homeless to voluntarily show up for care has proven difficult. Often times these populations don’t want to be found. This means that determining the extent of a disease in these populations is hard and managing the disease even harder.

The homeless and drug-using population are high-risk populations for sharing needles, a high-risk activity for contracting the hepatitis A vaccination. Ideally, vaccinations would be given prior to potential risk of such high-risk activities.

What About a Vaccination?

Vaccination efforts can go a long ways in helping to prevent future outbreaks of hepatitis A. Naturally most of the U.S. population is getting vaccinated as a child so as the older generations are overtaken but younger ones, more of the population will be safeguarded from hepatitis A by vacciantion. As far as what can be done for the unvaccinated right now, a variety of methods could be implemented to help address this issue. Offering the shots at clinics and having them available the same visit is helpful. Expecting the homeless and/or drug using population to come back to the clinic for a shot is not realistic. Having the shot on-hand will help address this issue. Others have suggested recommending vaccination for any individual who comes in for drug addiction.

San Diego is training its paramedics to give hepatitis vaccines, under a nurse’s supervision. This will help to reach more of the high-risk populations. A handful of studies provided strong empirical evidence that mass vaccination can work to prevent the spread of outbreaks, albeit after the infection has already harmed many people.