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Biological Health Hazard – Fatal Hepatitis A (HAV) Outbreak: San Diego County, California

2017/07/27

HEPATITIS A – USA (15): (CALIFORNIA) FATAL
****************
Published Date: 2017-07-26 19:28:04
Subject: PRO/EDR> Hepatitis A – USA (15): (CA) fatal
Archive Number: 20170726.5205912

Date: Tue 25 Jul 2017
Source: County of San Diego Health and Human Services Agency [edited]

Since early 2017, the Public Health Services Division in the County of San Diego Health and Human Services Agency has been investigating a local hepatitis A outbreak. The outbreak investigation is ongoing. It has been challenging because of the long incubation period of the disease (15 to 50 days) and the difficulty experienced to contact many individuals sickened with the illness who are homeless and/or illicit drug users. To date, no common source of food, beverage, or other cause has been identified; as a result, the source of the outbreak remains undetermined.

Vaccination efforts are being implemented in targeted locations by county staff and in collaboration with health care partners. Health providers are asked to inform the Epidemiology Program if they have a patient suspected to have the hepatitis A infection before the patient leaves the emergency department or provider’s office (see contact number below).

The table below will provide a weekly update of total cases, deaths, and hospitalizations. Following this update is information about hepatitis A to educate the community and help prevent the continual spread of this viral infection.

San Diego County Hepatitis A Outbreak Cases and Deaths as of 25 Jul 2017
————————-
Cases / Deaths / Hospitalizations
275 / 7 / 194 (71%)

Please note: Table does not include all reported hepatitis A cases in the county, only those that are local-outbreak-related. Also, data are provisional and subject to change.

Communicated by:
ProMED-mail
<promed@promedmail.org>

[The number of cases of diagnosed hepatitis A in San Diego County in southern California continues to increase, now over an almost 7-month period.

Date / Cases / Hospitalized (percentage) / Deaths (percentage)
————————————————————–
05 Apr 2017 / 39 / 33 (85) / 1 (3)
4 May 2017 / 80 / 66 (83) / 3 (4)
31 May 2017 / 133 / 103 (80) / 3 (2)
12 Jun 2017 / 160 / 120 (75) / 4 (2.5)
27 Jun 2017 / 196 / 142 (72) / 4 (2)
25 Jul 2017 / 275 / 194 (71) / 7 (2.5)

There have been 79 more cases over about 4 weeks and 142 more cases over about 8 weeks. Since many cases of HAV infection are asymptomatic or anicteric (without jaundice), the total number of cases is likely to have been significantly higher. It is not clear whether the newer cases are truly new or just newly reported older cases. An epidemiologic curve showing the date of onset of symptoms of cases over time could assist in this regard.

Thus, it remains unclear whether the persistent increase is related to slow reporting, increased awareness and testing, secondary cases, or the persistent source or sources in the environment. The very high hospitalization rate may be related to the homelessness of the cohort but could represent a more virulent strain. HAV infection occurred in some individuals chronically infected with either hepatitis B or C, but it is not clear whether the fatalities occurred in those individuals.

Homelessness and illicit substance use seem to be relevant risk factors, while homosexual practices are not. It remains unclear how and from what vehicle the virus is spreading.

The state of California can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/promed/p/787. San Diego County can be seen on the map at http://geology.com/county-map/california-county-map.gif. – Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/204.]

See Also

Hepatitis A – USA (14): (CO) RFI 20170725.5201341
Hepatitis A – USA (13): (CA) fatal 20170713.5173051
Hepatitis A – USA (12): (MI) fatal, RFI 20170707.5158430
Hepatitis A – USA (11): (CA) 20170629.5139711
Hepatitis A – USA (10): (CA) additional counties, RFI 20170615.5107437
Hepatitis A – USA (09): (CA) 2nd county, RFI 20170614.5105051
Hepatitis A – USA (08): (CA) fatal, RFI 20170613.5102106
Hepatitis A – USA (07): (CA) fatal 20170606.5087079
Hepatitis A – USA (06): (CO) MSM 20170512.5031179
Hepatitis A – USA (05): (CA) fatal 20170511.5028824
Hepatitis A – USA (04): (CA) fatal, RFI 20170506.5017836
Hepatitis A – USA (03): (OR) food workers 20170410.4959609
Hepatitis A – USA (02): (CA) fatalities 20170408.4956398
Hepatitis A – USA: (MI) increased incidence 20170324.4923927

2016
—-
Hepatitis A – USA (19): (MI) prepared food 20161022.4578285
Hepatitis A – USA (18): (HI) frozen scallops 20160930.4527512
Hepatitis A – USA (17): (HI) frozen scallops 20160915.4490624
Hepatitis A – USA (16): fruit smoothies, strawberries ex Egypt 20160915.4490623
Hepatitis A – USA (15): comment 20160910.4477503
Hepatitis A – USA (14): fruit smoothies, strawberries ex Egypt 20160909.4477372
Hepatitis A – USA (13): fruit smoothies, strawberries ex Egypt 20160903.4461205
Hepatitis A – USA (12): (HI) frozen scallops 20160903.4463425
Hepatitis A – USA (11): (MI) raw sewage contact 20160827.4445808
Hepatitis A – USA (10): (VA) fruit smoothies, imported strawberries 20160822.4431203
Hepatitis A – USA (09): (HI) frozen scallops 20160817.4422480
Hepatitis A – USA (08): (HI) 20160810.4405316
Hepatitis A – USA (07): (HI) 20160729.4376124
Hepatitis A – USA (06): (HI) 20160721.4360060
Hepatitis A – USA (05): (HI) 20160713.4342961
Hepatitis A – USA (04): (HI) RFI 20160707.4330783
Hepatitis A – USA (03): (HI) 20160703.4323888
Hepatitis A – USA (02): (PR) hospital workers 20160630.4314683
………………………………………….ll/msp/dk

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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