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The Hepatitis A Outbreak In San Diego Is Now A Public Health Emergency

The outbreak has infected nearly 400 people and left 15 dead.

Posted on September 7, 2017, at 5:57 p.m. ET

The San Diego Board of Supervisors ratified the declaration of a public health emergency on Wednesday as a result of an ongoing outbreak of hepatitis A, an infection that affects the liver.

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A local public health emergency was first declared by officials on Sept. 1 and signed into law by Regional Health Officer Dr. Wilma Wooten to raise awareness and allow the Health and Human Services Agency to request state assistance if necessary, the San Diego Union-Tribune reports. And on Sept. 6, the San Diego Board of Supervisors unanimously ratified the declaration and discussed new prevention efforts.

Since November 2016, the outbreak has infected hundreds of people and left 15 dead — with the homeless population hit the hardest.

According to the San Diego Health & Human Services Agency (HHSA), as of Sept. 5, the current outbreak has infected 398 people, causing 279 hospitalizations.

The San Diego HHSA wrote that the majority of the people who have been infected with the disease are either homeless or illicit drug users, and that the outbreak is being spread between people through contact with a "fecally contaminated environment" — i.e. when an uninfected or unvaccinated person ingests food or water, touches an object, or uses drugs contaminated with fecal matter from an infected person.

Hepatitis A is a contagious liver disease caused by the hepatitis A virus (HAV).

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The hepatitis A virus is one of several hepatitis viruses that causes inflammation and impaired functioning of the liver. According to the World Health Organization, hepatitis A can cause mild to severe illness and most people recover with lifelong immunity. However, some people can develop acute liver failure, which is often fatal.

Symptoms of hepatitis A include fever, diarrhea, nausea, dark-colored urine or feces, abdominal pain, and jaundice — but not everyone will have all of the symptoms. The severity of the disease and fatal outcomes are higher in older age groups, according to the WHO.

It's usually spread through the ingestion of contaminated food or water.

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According to the Centers for Disease Control, hepatitis A is primarily transmitted from person-to-person through the fecal-oral route but it can also spread between sex partners or through close physical contact with an infected person.

Because, according to the WHO, the disease is closely associated with poor personal hygiene, lack of hand-washing, and unsafe water or food sources, preventing it usually comes down to improved sanitation, food safety, and immunization.

There is a safe, effective vaccine that prevents against hepatitis A, which consists of two shots given six months apart.

The city's initial response to the outbreak included vaccination and education programs — but these failed to lower infection rates.

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According to a presentation by Dr. Wooten at the Board of Supervisors meeting on Sept. 6, approximately 19,100 individuals have been vaccinated for hepatitis A since March. This includes 7,318 people from at-risk populations such as the homeless, illicit drug users, food handlers, emergency responders, and health care workers.

Additional efforts included the distribution of "hygiene kits" and educational programs. However, these did not significantly lower the infection rate and reports of deaths have even spiked in the past weeks.

The emergency declaration is intended to help the county request state assistance for new sanitation measures — such as portable hand-washing stations.

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According to Dr. Wooten's presentation, the county has placed 40 portable hand-washing stations in areas of the city with high concentrations of homeless people. Additional measures include cleaning the streets with bleach-spiked water to remove bodily fluids. These sanitation and cleansing efforts are modeled off previous campaigns to prevent hepatitis A in Los Angeles, the San Diego Union-Tribune reports.

Hepatitis A epidemics can have serious economic consequences.

Because of the virus's ability to survive outside the body for months (depending on the environmental conditions) as well as its ability to withstand some food-safety processes used to remove or reduce bacterial pathogens, epidemics can be explosive, resulting in the shutdown of food establishments with connections to the virus. Plus, there's no specific treatment for hepatitis A other than supportive care and it can take weeks or months for those infected to recover and return to work and daily responsibilities. As a result, a hepatitis A epidemic can seriously impact economic health, too.

San Diego County staff will continue to provide vaccinations and implement sanitation measures in hopes that the outbreak will subside.

According to the HSSA website, the county is also asking health providers to inform their Epidemiology Program if they have a patient with a suspected hepatitis A infection.

A BuzzFeed News investigation, in partnership with the International Consortium of Investigative Journalists, based on thousands of documents the government didn't want you to see.