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Hepatitis A Update

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The County of San Diego declared a local public health emergency on Sept. 1, 2017 due to a hepatitis A outbreak in the county. The county is taking the lead on containing the outbreak focusing on vaccination, sanitation and education. The City of Carlsbad is coordinating with county health officials, following all of the recommended steps to help protect public health and is ready with resources should the county call for additional measures. For the latest information, please visit the County of San Diego Health and Human Services Agency website.

Why did the County of San Diego declare a local health emergency?

Due to the increase in Hepatitis A cases, the County of San Diego declared a local health emergency, which helps raise awareness of the outbreak and streamline access to resources that could be needed, such as the County Medical Reserve Corp. This is a team of trained health professionals who can assist with vaccinations and other services. An emergency declaration can also allow for easier procurement processes if additional supplies and materials are needed, and mutual aid among public agencies, if needed.

What area is covered by the local health emergency?

The entire County of San Diego is covered by the local health emergency.

Have there been Hepatitis A cases in Carlsbad?

As of early November, no cases have been formally reported in Carlsbad, however there have been recent cases in surrounding communities. It’s possible individuals in Carlsbad could have contracted Hepatitis A and not be aware or not sought treatment.

What is the City of Carlsbad doing to prevent the spread of Hepatitis A?

In addition to following all of the guidelines established by the County of San Diego Health and Human Services Agency, the City of Carlsbad has activated a multidepartment incident preparation and response team to do the following:

  • Educate the public and city employees about the outbreak and how to prevent infection.
  • Work with the county to arrange free vaccination for those most at risk in the community.
  • Increase cleaning of city operated restrooms and confirm they are well stocked and in good working order.
  • Increase cleaning and disinfection of public places, as needed.
  • Place handwashing stations and temporary portable restrooms in public locations as needed.
  • Coordinate any additional precautions needed with the County of San Diego. 

How serious is Hepatitis A?

Hepatitis A is a virus affecting the liver. Its symptoms, which are similar to the flu, typically last anywhere from a few weeks to a few months. Most people who get Hepatitis A recover completely. People with chronic liver disease, such as cirrhosis, Hepatitis B or C, and other health conditions are at increased risk of developing a severe illness, including death, if they are infected with Hepatitis A virus.

What is the risk?

The Hepatitis A virus is transmitted when human excrement from a person who has been infected by Hepatitis A is ingested by another person. The Hepatitis A virus can live for months in even a microscopic amount of feces outside the body (on door knobs and park benches for example). That’s why it’s so important that people wash their hands properly after using the bathroom and before eating. It’s not spread through coughing (airborne) or contact with blood or other bodily fluids, only feces.

How can I protect myself?

Don't put anything in your mouth, including your hands, if there is any chance human feces is present, even in microscopic amounts. Proper handwashing is the most effective way to prevent infection. The Centers for Disease Control and Prevention recommend the following:

  • Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap.
  • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them.

Since hand washing is the most important thing you can do to prevent infection, you might be interested in reading more about the science behind it (including why antibacterial soap is not effective in killing viruses and why hand sanitizer is not as good as good old fashioned soap and water).

Why isn’t hand sanitizer as good as hand washing?

Hand sanitizers are more effective in killing bacteria than not viruses. If you cannot wash your hands with soap and water, using hand sanitizer is better than not cleaning your hands at all.

What else can I do to protect myself against Hepatitis A?

Avoid any activity that could result in even a microscopic amount of human feces getting into your mouth. These particles could be on door knobs, “walk” buttons on traffic signals and other places commonly touched by large numbers of people. Towels and toothbrushes could carry these particles too.  Generally speaking, follow good hygiene practices and always wash your hands before eating.

Why is Hepatitis A such a concern lately?

San Diego County has seen an increase in cases among the homeless population, who often lack access to proper sanitation. Many of those infected have not had access to health care and had other conditions that made them more vulnerable to the virus. It's important to note that the Hepatitis A outbreak is not limited to people who are homeless.

Should I get vaccinated?

The vaccines has been part of the childhood immunization schedule since 1994. If you did not already get the vaccine, call your medical provider, pharmacist or 2-1-1 to find a community clinic or public health center near you to discuss whether the Hepatitis A vaccine is recommended for you. The County of San Diego recommends the following groups get vaccinated:

  • People who are homeless
  • People who have close, ongoing contact with people who are homeless
  • People who use illicit drugs and those who have contact with them, such as health care, public safety and sanitation workers
  • Individuals who work in homeless shelters and homeless and drug treatment service provider agencies
  • Food handlers
  • Travelers to countries where Hepatitis A is common 
  • Family and caregivers of adoptees from countries where Hepatitis A is common
  • Men who have sexual encounters with other men 
  • Users of recreational drugs, whether injected or not 
  • People with chronic or long-term liver disease, including Hepatitis B or Hepatitis C
  • People with clotting-factor disorders

You can take this online risk calculator to see whether the Centers for Disease Control and Prevention would recommend you be vaccinated. 

Why are Baby Boomers at a higher risk?

Having Hepatitis C makes you more vulnerable to the effects of Hepatitis A. According to the Centers for Disease Control and Prevention, people born between 1945 and 1965 are five times more likely to have Hepatitis C than other people. The reason that people born from 1945–1965 have high rates of hepatitis C is not completely understood. Most baby boomers are believed to have become infected in the 1960s through the 1980s when transmission of Hepatitis C was highest. Hepatitis C is primarily spread through contact with blood from an infected person. Baby boomers could have gotten infected from medical equipment or procedures before universal precautions and infection control procedures were adopted. Others could have gotten infected from contaminated blood and blood products before widespread screening virtually eliminated the virus from the blood supply by 1992.

What’s the difference between Hepatitis A, B and C?

Hepatitis A, Hepatitis B and Hepatitis C are three different and common viruses that can cause hepatitis, or inflammation of the liver. Each virus has a different way of spreading and can affect the liver differently.

  • Hepatitis A appears only as a new infection and does not become long-lasting. Healthy people with Hepatitis A usually improve without treatment. People with chronic liver disease who get Hepatitis A have an increased risk for complications or even death.
  • Hepatitis B and Hepatitis C can also begin as new infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is no vaccine for Hepatitis C.
  • If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

How long does the Hepatitis A virus survive outside the body?

The Hepatitis A virus is extremely hardy. It is able to live outside the body for months, depending on the environmental conditions. According to the CDC, high temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F kills the virus, but freezing temperatures do not.

What are the symptoms of Hepatitis A?

Some people with Hepatitis A do not have any symptoms. Symptoms can develop two to seven weeks (15-50 days) after exposure to the virus. Adults are more likely to have symptoms than children. If you do have symptoms, they may include the following:

  • Jaundice (yellowing of the skin or eyes)
  • Clay-colored or pale stools (bowel movements)
  • Dark urine
  • Fever
  • Fatigue
  • Nausea
  • Loss of appetite
  • Vomiting
  • Stomach pain
  • Joint pain

Can a person spread Hepatitis A without having symptoms?

Yes. Some people, especially children, show no symptoms. In addition, a person can be infectious and spread the virus to others for up to two weeks before symptoms appear and for one week after developing jaundice (yellowing of the skin and eyes).

I was near someone who I think had Hepatitis A recently. What should I do?

If you think you might have been exposed to someone with the Hepatitis A virus and have not been vaccinated against Hepatitis A, you would benefit from an injection of the Hepatitis A vaccine or immune globulin. However, the vaccine or immune globulin must be given within the first two weeks of exposure to be effective. A health professional can decide what is best based on your age and overall health.

Where can I get vaccinated?

Call your medical provider, pharmacist or 2-1-1 to find a community clinic or public health center near you to request the Hepatitis A vaccine. The vaccine is readily available, however, priority is usually given to those who are at a higher risk.

How long will I be protected?

According to the CDC, protective levels of antibody to the Hepatitis A virus could be present for at least 25 years in adults and at least 14–20 years in children. If you are unsure of when or if you were vaccinated and are at high risk, you can get the vaccine again.

How many shots of the Hepatitis A vaccine do I need?

The Hepatitis A vaccine is given as two shots, six months apart. You will be protected approximately two to four weeks after the first injection, and the first shot is about 90 percent effective. If you do not remember whether you were vaccinated, ask your medical provider. Repeating the vaccination series is not harmful.

Is there enough vaccine supply for all recommended groups in the entire county?

Yes. Currently, there are no shortages of this vaccine locally or nationally.

How should I disinfect my home or business for Hepatitis A?

Maintain routine and consistent cleaning of bathrooms for employees, public and personal use. Using a chlorine-based disinfectant (bleach) with a ratio of 1 and 2/3 cup of bleach to one gallon of water (5000 ppm). Mix and use the chlorine solution promptly. Allow one minute of contact time. Due to the high bleach concentration of this mixture, rinse surfaces with water after one minute of contact time and wear gloves while cleaning. Use for stainless steel, food/mouth contact items, tile floors, nonporous surfaces, counters, sinks and toilets.

Where can I get more information?

  • Call 2-1-1, the County of San Diego’s health and human services hotline
  • Call the California AIDS, STD and Hepatitis Hotline—800-367-AIDS (2437)
  • Centers for Disease Control and Prevention Information Hotline—800-CDC-INFO (232-4636)

Online Resources

Centers for Disease Control and Prevention

County of San Diego Health and Human Services Agency


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October 14, 2017