California / Hepatitis A Outbreak 2017

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Who was 'patient zero' in California hepatitis outbreak?
http://www.vcstar.com/story/news/20...zero-california-hepatitis-outbreak/786767001/

"In the case of the locals outbreak, the El Cajon patient is considered patient zero because he was homeless and a blood test showed the presence of hepatitis A antibodies, according to the county’s McDonald. Those two facts are enough to make it statistically likely he was infected by one of the 15 or more hepatitis A viral strains that have caused the outbreak.

But no local public health investigator has ever interviewed or traced this first patient’s movements through the community, because they have been unable to find him.

That’s too bad, because outbreak investigations work through a process called “contact tracing” which seek out each person who was in contact with an infectious person. Making contact with first patients early on allows a public health department to more accurately focus their vaccination efforts.

While a name was recorded when the individual was seen in the hospital in late November, Wooten said he was treated and released long before anyone at the county realized that an outbreak was underway in March of this year.

“We have not had the ability to contact the first index case in this outbreak,” Wooten said.

To date, because the man has not been located, his blood has not been able to be analyzed for the same strain of hepatitis that is causing the outbreak.

So, it’s technically possible that “patient zero” was actually infected by a hepatitis A virus with a different genetic fingerprint not directly related to the outbreak cases."
 
County extends hepatitis state of emergency as cases*decline
http://fox5sandiego.com/2017/11/06/county-expected-to-extend-hepatitis-a-emergency-declaration/

"SAN DIEGO -- The Board of Supervisors Monday extended a state of emergency over a hepatitis A outbreak in San Diego County that has killed 20 people, amid a declining number of new cases.

Health officials told the supervisors at a special meeting that the drop in case numbers is a sign that efforts to fight the outbreak are working. They stressed the need for the county to continue vaccination, prevention and educational efforts that have been put in place since the emergency was declared in September."
 
Tourists came to San Diego for Metallica, left with hepatitis A
http://www.sandiegouniontribune.com...sd-me-hepatitis-metallica-20171109-story.html

"The weekend of the concert, Johnson said he and his friends “had a ball,” riding bikes on the Pacific Beach*boardwalk, swimming in a hotel pool downtown, and eating and drinking at local bars and restaurants.

Johnson said he contacted U-T Watchdog because of one restaurant in particular."
 
"According to county health officials, at least 17 food-service workers have been infected so far. Besides the case at World Famous, the county has not notified the public of food service worker infections. Officials say the other cases were not publicized because the infection was not identified in time for exposed members of the public to protect themselves with a vaccine."

http://www.sandiegouniontribune.com...sd-me-hepatitis-metallica-20171109-story.html
 
La Jolla church ends homeless feeding program because of Hepatitis*A
http://fox5sandiego.com/2017/11/10/...eless-feeding-program-because-of-hepatitis-a/

"The church originally received a letter from the La Jolla town council asking them to stop serving the poor because of the homeless being attracted to the area.

The death toll in an almost year-long hepatitis A outbreak in the San Diego region has reached 20, county health officials reported in October.

In light of the Hepatitis A outbreak, the pastor of the church decided to end the feeding program indefinitely.

“I don’t want to be known as the pastor that brought Hepatitis to La Jolla,” said pastor*Jim Rafferty."
 
Tourists say they contracted Hepatitis A on San Diego trip
http://www.kvia.com/lifestyle/healt...acted-hepatitis-a-on-san-diego-trip/654143650

"San Diego, CA - Two tourists from Utah who visited San Diego this summer say they believe they contracted hepatitis A on their trip.
** *
Mike Johnson and Josh Oviatt told the San Diego Union Tribune that they were in San Diego in August. They both were diagnosed with the liver-damaging virus a month later. The 44-year-old Oviatt was hospitalized for four days. A third friend traveling with them had been vaccinated and did not get sick."
 
"Wooten said during her presentation Monday, as she and other local officials have said in recent weeks, that the number of new cases reported to her department on a day-to-day basis has continued to decline.

“The number of cases that are being reported daily now has recently decreased to one or two a day compared to three or more a day,” Wooten said."

Hepatitis A outbreak continues to grow, but more slowly
http://www.sandiegouniontribune.com...s/sd-me-hepatitis-numbers-20171106-story.html
 
Gay and bisexual men at higher risk of hepatitis A in L.A. County as outbreak grows
http://www.latimes.com/local/lanow/la-me-ln-lapd-hepatitis-20171109-htmlstory.html

"Most of the 20 people killed and more than 600 sickened in the outbreak that began in San Diego were homeless. But cases have begun to surge in Los Angeles County among gay and bisexual men who are not homeless. And an LAPD officer who works on skid row was recently infected with the virus.

As a result, county officials have called for first responders, members of law enforcement working in the field and men who have sex with men — as well as homeless people — to get vaccinated against hepatitis A."
 
"“The sheer number of cases … is what’s alarming,” said Dr. Adam Cohen, director of advocacy and policy research for the AIDS Healthcare Foundation.

The uptick is particularly worrisome because there have been recent large hepatitis A outbreaks among gay men in Colorado and New York, as well as in Chile and several countries in Europe, said Dr. Prabhu Gounder, a medical epidemiologist with L.A. County’s public health department.

“What we were concerned about is that we’re at the beginning of a similar trend in L.A, and we wanted to get ahead of that,” Gounder said. Some in L.A. County who are infected had traveled to regions with outbreaks, he said."

http://www.latimes.com/local/lanow/la-me-ln-lapd-hepatitis-20171109-htmlstory.html

(Eta: This is the first time I'm seeing Colorado being mentioned...)
 
"Dr. Takeshi Saito, a professor who studies viral hepatitis at the USC Keck School of Medicine, said the hepatitis A virus is highly contagious and can tolerate extreme temperatures.

Hepatitis A has survived in frozen berries and infected people who’ve eaten them. Even when someone washes their hands without soap, they might reduce the amount of the virus but won’t necessarily eliminate it, Saito said."

http://www.latimes.com/local/lanow/la-me-ln-lapd-hepatitis-20171109-htmlstory.html
 
Hepatitis A Is Surging And Cities Don’t Have The Resources To Stop ItCases have jumped 28 percent this year, and there’s a “constrained supply” of vaccine.
https://www.huffingtonpost.com/entry/hepatitis-a-2017-vaccine_us_59f21cc6e4b07fdc5fbcd1ef

"But this year’s unexpected surge has led to a “constrained supply” of the vaccine needed to stop it, according to the U.S. Centers for Disease Control and Prevention.*

Experts have been unable to pinpoint the reasons for this year’s explosion of cases from Michigan to Colorado, other than noting unsanitary conditions in some of the homeless and illicit drug-using populations that are primarily affected."
 
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https://www.huffingtonpost.com/entry/hepatitis-a-2017-vaccine_us_59f21cc6e4b07fdc5fbcd1ef
 

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"The states and cities battling outbreaks this year report a variety of strains of the disease, and factors suspected in its spread. Michigan has seen 457 cases this year and 18 deaths, primarily among its homeless population. New York City has seen 95 cases, due primarily to sexual contact.

“There’s no real rationale for where it happens in one place rather than another,” Duchin said. “The rapidity at which [hepatitis A is] going through the population and potentially getting into the general community is a real threat.”"

https://www.huffingtonpost.com/entry/hepatitis-a-2017-vaccine_us_59f21cc6e4b07fdc5fbcd1ef
 
"Nationwide, however, the vaccine shortage may be jeopardizing prevention efforts as the CDC works to prioritize vaccine distribution where it’s needed most.

A first dose of the vaccine is 90-percent to 95-percent effective, and a second dose practically guarantees immunity. But second-dose campaigns are being put off until the spring in San Diego. According to the CDC website, second-dose efforts can be delayed in times of vaccine shortages.

Duchin said he was alarmed when the CDC told him it was only allocating Washington state 40 doses of vaccine per month. That limited supply will likely force Seattle to stop preventive efforts aimed at inoculating high-risk homeless people, Duchin said.

Merck and GlaxoSmithKline, the two pharmaceutical companies that manufacture the hepatitis A vaccine, both told HuffPost that manufacturing constraints due to unexpected global demand were to blame for the “constrained supply.”*Europe has seen a similarly alarming surge, primarily among gay, bisexual and other men having sex with men.

Vaccines were on backorder until this week, and both companies said they hoped to begin resupplying stocks in November."

https://www.huffingtonpost.com/entry/hepatitis-a-2017-vaccine_us_59f21cc6e4b07fdc5fbcd1ef
 
"A Lack Of Critical Funding

The outbreaks also are soaking up funding for state and local health departments. San Diego County’s health department has spent $4 million combatting the outbreak so far, and anticipates spending an additional $1.5 million each month until it is under control for vaccination and information campaigns, according to Wooten.*

The CDC gets “a pittance” of $34 million for prevention of all viral hepatitis, Laura Hanen,*interim executive director and chief of public affairs of the National Association of County and City Health Officials, said.

That works out to about $90,000 per state to fight hepatitis A, B, and C. And even the cheapest treatment for hepatitis C costs in the tens of thousands of dollars.

“Overarchingly viral hepatitis prevention has been woefully underfunded given the size of the folks affected by hepatitis A, B and C,” Hanen said. ”The challenge since the economic downturn occurred is we are living under exceedingly tight [public health] budgets.”

Hanen blames an erosion of public health and infrastructure resources for allowing outbreaks to pick up steam. Since 2008, public health departments nationwide have lost 43,000 employees, she said.

“If you don’t prevent, you pay a lot more in outbreak investigation and treatment,” Hanen said. ”We tend to only pay attention when there is a crisis, and I think that’s the challenge with hepatitis and vaccine-preventable diseases. So, when you disinvest in prevention, you have to expect there will be an increase in outbreaks. And therefore, we have to spend even more money than if we had maintained a robust investment over time.”

Duchin warned the lack of investment in prevention could lead to more disease outbreaks.

“We are stretched thin on the federal and local level to combat such an outbreak. We don’t have resources for these types of [prevention] activities, and it’s very challenging,” Duchin said."

https://www.huffingtonpost.com/entry/hepatitis-a-2017-vaccine_us_59f21cc6e4b07fdc5fbcd1ef
 
Hepatitis A Outbreak May Impact Thanksgiving Volunteers
https://www.nbcsandiego.com/news/lo...Impact-Thanksgiving-Volunteers-456563383.html

"But non-profit organizations, like Feed San Diego, are willing to take the risk. They say that Thanksgiving is the busiest time of year for them and the demand is high.

Vince Hall, CEO of Feed San Diego, told NBC 7 that more volunteers keep showing up despite the epidemic.

They've actually seen a 25 percent increase in volunteers this fiscal year compared to last."
 
2017 Colorado hepatitis A outbreak
https://www.colorado.gov/pacific/cdphe/hepatitis-a-outbreak-2017

"Hepatitis A case count | 62 total cases as of November 3rd , 2017"

(Just great...Colorado has a huge homeless population, Boulder, Denver, etc...I can see this situation escalating rapidly...)

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Hepatitis A cases in Colorado are skyrocketing in 2017
Officials urge vaccination, especially among the most vulnerable groups
http://www.denverpost.com/2017/08/30/colorado-hepatitis-a-cases-spike/

"The number of cases of hepatitis A in Colorado so far this year is*already double*the yearly average, and health officials are urging more people to get vaccinated, especially if they are in a vulnerable population."

*******

Hepatitis A cases double in Colorado from last year
http://www.thedenverchannel.com/news/local-news/hepatitis-a-cases-double-in-colorado-from-last-year

“"If you eat out, if you like any kind of fruits and vegetables, at some point you will be exposed to this virus and you could get sick from it,” said Dr. Michelle Barron, UCHealth’s Medial Director of Infection Prevention and Control.

Dr. Barron says Hepatitis A is highly contagious and can be spread by unwashed hands, contaminated food or drinks, or sexual transmission.

“Typically, after you ingest this, within a couple of days you feel like you have flu-like symptoms, not quite feeling right, low-grade fever, maybe some body aches, and then you turn bright yellow,” said Dr. Barron."

*********

"The outbreak has been heaviest this year in El Paso County, where 12 cases have been reported, followed by Adams County with 9 cases and Denver with 8."

What you need to know about Colorado’s Hepatitis A outbreak
https://www.denverite.com/what-you-need-to-know-about-colorados-hepatitis-a-outbreak-43093/

*********

"State Epidemiologist Dr. Rachel Herlihy says about 75 percent of the cases have been men, and about half of those are men who have had sex with other men.

Herlihy says the Colorado numbers mirror trends elsewhere, including New York State and Western Europe."

Hepatitis A Cases Increasing In Colorado
August 31, 2017
http://denver.cbslocal.com/2017/08/31/hepatitis-a-colorado/

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Hepatitis A cases surge in Colorado, El Paso County
https://m.gazette.com/hepatitis-a-cases-surge-in-colorado-el-paso-county/article/1612104

"In Colorado and El Paso County, most cases involved men having sex with men, or people visiting adult bookstores or adult arcades, health officials said.

Few of the infected people here have been homeless. But one who was recently forced El Paso County health officials to swiftly open two temporary clinics to halt its spread.

Last week, county health officials gave vaccination and immunoglobulin shots to 62 people exposed to a person with hepatitis A who stayed at the Salvation Army's homeless shelter, 709 S. Sierra Madre St."

Snip

""It is a vaccine that is given now routinely to all children - but not all adults, because that recommendation has only been in place for a number of years," Herlihy said. "So we do know there is a substantial proportion of the adult population in Colorado that is quite vulnerable to infection.""

**********
 
margarita25 said:
"“The sheer number of cases … is what’s alarming,” said Dr. Adam Cohen, director of advocacy and policy research for the AIDS Healthcare Foundation.

The uptick is particularly worrisome because there have been recent large hepatitis A outbreaks among gay men in Colorado and New York, as well as in Chile and several countries in Europe, said Dr. Prabhu Gounder, a medical epidemiologist with L.A. County’s public health department.

“What we were concerned about is that we’re at the beginning of a similar trend in L.A, and we wanted to get ahead of that,” Gounder said. Some in L.A. County who are infected had traveled to regions with outbreaks, he said."

http://www.latimes.com/local/lanow/la-me-ln-lapd-hepatitis-20171109-htmlstory.html

(Eta: This is the first time I'm seeing Colorado being mentioned...)
Click to expand...

I guess I am confused as to why this is more prevalent among gay men. Hep A can be spread just from casual contact, not necessarily sexual activity. Is there some reason this demographic is more at risk?
 
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