State to buy more hepatitis A vaccine after emergency declaration
California’s multi-county hepatitis A outbreak has so strained the federal government’s supply of vaccine that the state will take its own steps to secure more doses directly from manufacturers under an emergency declaration declared by Gov. Jerry Brown Friday.

California’s multi-county hepatitis A outbreak has so strained the federal government’s supply of vaccine that the state will take its own steps to secure more doses directly from manufacturers under an emergency declaration declared by Gov. Jerry Brown Friday.

Dr. Gil Chavez, state epidemiologist and deputy director of the Center for Infectious Diseases at the California Department of Public Health, said that the state has already received more than 80,000 free doses from a federal “317” emergency vaccine program run by the U.S. Centers for Disease Control and Prevention.

“In our communications with them, as of late, it’s been very clear that our continuous requests for additional vaccine is running into their limit of what they can share with California,” Chavez said.

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He did not elaborate on how low the state’s supply of hepatitis A vaccine has dropped and noted that local public health departments and health providers also have the ability to order vaccine outside of the federal program. But, he said, it is time for his department to start buying what is needed to keep existing vaccination campaigns in San Diego, Los Angeles and Santa Cruz counties supplied with as many vials as they require.

“We have received 81,000 doses (from the CDC), and that is a big chunk of their total supply for the entire country for the year. CDC has been trying to manage their inventory to meet the needs of California,” Chavez said.

The governor’s emergency declaration, signed Friday, gives the state health department authority to “take all measures necessary to obtain hepatitis A vaccines and prioritize the vaccination of at-risk individuals.” Chavez said he did not have an immediate estimate of exactly how many more doses the state will need to buy or how much doing so might cost.

Also on Friday, Rep. Darrell Issa, R-Vista, sent a letter to the U.S. Department of Health and Human Services and the CDC requesting federal assistance, including any available emergency grant funding, to help fight the outbreak.

In addition to allowing San Diego and other California counties dip into its emergency vaccine supply, the CDC has already provided some personnel, flying several of its epidemiologists out to advise local public health teams on the best ways to contain the spread of hepatitis A infections. So far, however, those efforts have not been able to turn the corner. Case totals increased to 490 this week and the death total hit 18.

Other totals around in California:

71 cases in Santa Cruz County

13 cases in Los Angeles County

7 cases elsewhere in the state

The CDC has been unclear about exactly how much current outbreaks in California, Michigan, Utah and Arizona are drawing down the national vaccine supply which was already challenged by a global increase in demand due to a series of overseas outbreaks.

In late September Merck & Co. Inc., manufacturer of VAQTA, one of two FDA-approved hepatitis A vaccines, told the Union-Tribune that it “anticipates working through some manufacturing constraints” in 2017, adding that “constraints will impact availability of pediatric and adult doses of VAQTA this year.”

At a news conference in San Diego last week, a CDC spokesperson promised to clarify the vaccine supply picture, but has not subsequently provided any additional information.

The vaccine supply question persists as San Diego organizations ready for a fresh wave of inoculation activity.

On Friday morning, Mayor Kevin Faulconer stood beside paramedics to announce that a temporary modification of state law has allowed the city to create two mobile vaccination teams which will include a paramedic, a fire captain/paramedic and a supervising nurse. Under temporary permission from the state Emergency Medical Services Authority, paramedics in San Diego County are allowed to give hepatitis A shots to at-risk residents as long as they are working under the direct supervision of a registered nurse.

City fire officials and Mike Murphy, general manager of American Medical Response-San Diego, said paramedics who will be involved in vaccination efforts have received four additional hours of training on the proper technique for giving hepatitis A shots. The activity is similar to other injections they often administer answering emergency calls throughout the city.

San Diego Fire Department Battalion Chief Rick Ballard said after Friday’s news conference that he expects the city to learn where and when the two paramedic teams will work from the county Health and Human Services Agency on Monday. He said the county is working with many medical organizations, including local hospitals, to fan out to single-occupancy hotels, beaches, parks and other locations.

“They’ve identified over 100 locations that they have not been able to reach yet,” Ballard said.

The county did not respond Tuesday to a request for more information on its impending second-wave vaccination effort, and a county spokesman said Friday afternoon that he still could not make anyone available to discuss the operation’s details.

In recent weeks some in the community have questioned whether the San Diego River may be a source of hepatitis A infection among the city’s homeless. While county public health officials have insisted that river water is not a source of contamination, they told the Union-Tribune Thursday that river water has not yet been tested for contamination by one or more of the 15 unique strains of the virus that testing has found in samples gathered from infected residents.

A recent genetic test of river water, while it did not specifically check for hepatitis, did find that the total amount of human feces in the river and its tributaries quadrupled in 2017.

On Thursday San Diego City Councilman David Alvarez sent a memo to Mayor Faulconer requesting that the city test local waterways for hepatitis A. The city has no current plans to start testing, Greg Block, Faulconer’s senior press secretary, said in an email.

“The county has consulted with the Center for Disease Control and environmental sampling has not been recommended for the current hepatitis A outbreak. The county is the public health agency for the region, and we rely on their expertise in these matters,” Block said.

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paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson