Fixing San Diego County's poor response to 2018 Hepatitis-A outbreak

Nothing that our local, state or national government does is more important than responding to public health and safety. Nothing.

In 2017-2018, the County of San Diego Health and Human Services Agency announced a detected increase in hepatitis-A cases. According to the U.S. Centers for Disease Control and Prevention, hepatitis-A is a highly contagious liver disease that can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

During this outbreak in San Diego County, 587 cases were reported, 402 patients were hospitalized and 20 patients died as the result of this deadly infectious disease. The disease was disproportionately affecting the homeless population and also created high risk to all our communities in North County.

Hepatitis-A is transmitted in a number of commonly occurring ways, such as, when infected individuals do not wash their hands adequately after using the restroom and touch objects or food that others subsequently touch or ingest.

The transient nature of the homeless and illicit drug‑using populations, as well as challenges in building trust and engaging with these individuals, requires that county officials collaborate with local community and other public organizations to prevent a widespread epidemic. Despite its infectious characteristics, hepatitis-A is a preventable disease with a safe and effective vaccine. A single dose of the vaccine within two weeks of contact with the virus may prevent a person from developing the disease and spreading it to others.

So what happened? How did hepatitis-A spread from San Diego to Orange, Los Angeles and Santa Cruz counties? Simply stated, San Diego County did not take critical steps in the early months of the outbreak and the result was the disease quickly spread, including to reported patients in Escondido and Fallbrook.

Had the county health officer declared a local health emergency sooner, the county could have significantly accelerated the procurement process and contained the health risk of many infected. As the result, the San Diego County Grand Jury issued a report in May 2018, recommending that the county and local cities immediately declare a local public health emergency and revise its emergency operations plan. These findings were followed and restated by recommendations by the California State Auditor in December 2018.

This week, the California State Assembly introduced AB 262, adding Section 120175.5 to the California Health and Safety Code and creating a state mandated local program requiring a local health officer to notify and update the local public entities within the health officer’s jurisdiction about communicable disease outbreaks that may affect them, and make relevant information available to those entities, as specified.

By avoiding delay, this bill would allow the county health officer to issue directives to other local cities within that jurisdiction to take any action the health officer deems necessary to control the spread of the communicable disease. This is a common sense fix and responds to the state auditor’s findings promptly to avoid any repeat to the hepatitis-A experience last year.

Call our state representatives, Assemblymember Waldron (916-319-2075) and Senator Jones ((916) 651-4038), and ask them to support AB 262.

Alan Geraci