Los Angeles County has declared a community-wide outbreak of hepatitis A. This is a highly contagious viral disease that can lead to liver damage and death.
Hepatitis A cases are not new in the region, but health officials are currently warning both for the prevalence of the disease and for those infected.
The total 165 cases recorded in 2024 are three times the number seen in the previous year, the highest in the county in at least 10 years, officials say. Seven deaths are currently linked to an outbreak of 13 months.
Historically, hepatitis A infection in LA County has been primarily identified in homeless people. Limited access to toilets and hand washing facilities helps spread the disease more easily, county health officials say. However, most infectious diseases have been reported this year among people who are not homeless and among people who have not traveled or used other common risk factors, illicit drugs.
“This shows that prompt action is needed to protect public health,” said LA County Health Officer Dr. Muntu Davis in a statement Monday that urged people to be offset by illness.
In the first three months of this year, 29 cases have been reported, twice the total seen in comparable periods last year.
The highly contagious virus is found in the stool and blood of an infected person and can contract by unconsciously taking contaminated foods and drinks. Using drugs, sexual contact with infected people, and sexual contact with infected people are also common means of infection, according to the Centers for Disease Control and Prevention.
The number of confirmed cases in LA County is almost certainly an understatement of the true prevalence of the disease, as infection may not be diagnosed. Still, this outbreak is already far greater than LA County’s most significant outbreak of hepatitis A in the past decade when 87 confirmed cases were reported in 2017.
“We definitely think that the outbreak is greater than the numbers imply,” said Dr. Sharon Balter, director of the Department of Infectious Disease Prevention and Prevention in LA County. Balter urged health care providers to test for hepatitis A if they thought the patient’s symptoms were consistent with the illness.
The outbreak is also beginning to be evident in LA County wastewater data, Balter said. Authorities had hoped that lower virus levels would suggest that the outbreak would be moderated in the second half of 2024, but they began to rise again.
Wastewater monitoring offers better ideas about the true scale of the presence of hepatitis A in the community because “many people may not seek care when they are infected” – being asymptomatic or not accessing health care.
Symptoms of hepatitis A include fever, fatigue, stomach pain, nausea, yellowing of the skin and eyes, and dark urine. According to the CDC, infection usually causes symptoms among adults, with yellowund occurring in over 70% of patients. Of children under the age of 6, approximately 70% of infectious diseases are asymptomatic.
Most people will fully recover from the illness, but “but sometimes it can lead to liver failure and death,” Butter said.
Genetic analysis shows that the strains identified in this outbreak were primarily found in LA county, said Dr. Prabh Gaunder, medical director of the Department of Viral Hepatitis, LA County Public Health. Several cases associated with this strain have also been identified in Orange and San Bernardino County.
There is a vaccine for hepatitis A. This was recommended in 1996 by the CDC’s Advisory Committee on Vaccination Practices for Young Children in 2006 in the area with the highest rate of disease.
“The vaccine is very effective,” Gounder said.
The CDC recommends that all children be vaccinated for hepatitis A at the age of 1 or 2. The shots are administered as a two-dose schedule, as they are separated for at least six months. Older children and adults can also receive the vaccine.
However, vaccinations against hepatitis A were never required as a condition of entry into a California kindergarten or parenting center.
“This means we have a large cohort of adults who may not be vaccinated,” Butter said.
Due to the outbreak, the LA County Public Health Department is strongly encouraging the hepatitis A vaccination as follows:
LA County residents who have not previously been vaccinated and are seeking parents who have experienced homeless people using drugs that include non-injectable drugs.
“It’s a very safe and very effective vaccine. You can get it through you [healthcare] Mr. Balter can go to the provider or pharmacy. Millions of hepatitis A vaccination doses have been given since the 1990s, the CDC says.
People experiencing homelessness and those using drugs “should get a vaccine in particular,” Butter said.
If you’re not sure if you’ve been vaccinated, it’s still safe, even if that means you’ll be vaccinated again.
“If you don’t know, you should just go and get vaccinated,” Barter said.
If you already have both vaccine doses, you don’t need to get additional shots, with a few exceptions. For example, bone marrow transplant patients may need to be revaccinated.
Another way to protect yourself is to wash your hands regularly with soap and water, especially after using the bathroom or before preparing and eating food, Balter said.
“When using hand sanitizers, you’re actually looking for hand sanitizers that contain more than 60% alcohol. Many hand sanitizers aren’t,” Balter said, noting that low-alcohol options don’t always eliminate the virus.
According to the CDC, it can take 15 to 50 days between exposure and illness. Mild hepatitis inflammation can last from one to two weeks, while severely disabled illness can last for several months. Approximately 10% to 15% of infected people have “symptoms that have either been prolonged or recurred over six to nine months,” the CDC said.
Due to the long incubation times, “We really have to go further than this,” Gounder said. “What we’re seeing now [are cases resulting from] An exposure that happened seven weeks ago. ”
Hepatitis A can be difficult to diagnose because the early symptoms may be mistaken for gastroenteritis or gastric influenza, Gounder said. More obvious signs of infection, such as yellow eyes, may appear later, but probably only after the virus tests begin to show negative.
Diseases similar to hepatitis A have been recorded since ancient times, but in the 1970s the virus was isolated. Hepatitis A was much more common before the highly effective vaccine was approved for use in the US in 1995.
According to the CDC, hepatitis A fell 95.5% between 1996 and 2011, but from 2016 “revival has been documented due to widespread outbreaks among people reporting drug use and homelessness.
One area that saw a significant spread of the disease was San Diego County, which recorded 20 deaths and 592 cases during the outbreak that began in 2016 and ended in 2018.
Hepatitis A in 2017 in LA County “ends over with an incredible effort” by public health officials to provide vaccines to those who can’t get it and raise public awareness of the disease, Butter said.
Of 165 cases of hepatitis in LA County last year, officials said, most were among adults. “These are probably people who hadn’t been vaccinated before and for some reason weren’t exposed as children,” Barter said.
It is valuable to detect the extent of current occurrences from wastewater data, officials say. However, federal budget cuts could affect such services in the future.
“Absolutely we’re worried about the impact of [reduced federal] “We fund our ability to protect LA County from things like outbreaks like hepatitis A,” Butter said.
The recently released federal budget proposal will significantly reduce or eliminate many grants, including the capacity of epidemiology labs and hospital preparation, Balter said.
“These will really affect our ability to track illnesses, especially our ability to respond to them. So we are definitely very concerned about it,” Barter said.
Another concern is the threat of reducing vaccine funding. If funding is cut, “we will lose the substantial source of free vaccines we need to boost our immunity, which is what we need to happen to stop this outbreak in the end,” Gounder said.
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