Hepatitis death count hits 18 in San Diego outbreak
Another death was connected to San Diego’s ongoing hepatitis A outbreak Tuesday even as the number of confirmed cases and hospitalizations showed their smallest increases in weeks. The county Health and Human Services Agency released its weekly update on the outbreak, bumping the number of deaths from 17 to 18. The number of confirmed cases grew by nine, reaching 490.

San Diego County Public health nurse Summer Leal puts a Bandaid Terrie Woolever’s upper arm after giving her a hepatitis shot at the City of San Diego’s new tent city at 20th and B streets Monday.

Another death was connected to San Diego’s ongoing hepatitis A outbreak Tuesday even as the number of confirmed cases and hospitalizations showed their smallest increases in weeks.

The county Health and Human Services Agency released its weekly update on the outbreak, bumping the number of deaths from 17 to 18. The number of confirmed cases grew by nine, reaching 490.

The latest death occurred in September and the public health department had been awaiting confirmation from the U.S. Centers for Disease Control and Prevention before adding it to the outbreak total.

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Dr. Wilma Wooten, the county’s public health officer, said Tuesday that another death has since been reported, starting the multi-week wait for confirmation that the death was caused by one of the 15 strains detected in San Diego’s outbreak which has now spread to other locations in California as well as Arizona and Utah.

Wooten went before the county Board of Supervisors Tuesday to request that the local public health emergency she declared on Sept. 1 be renewed for another two weeks. She said the county and local health providers have now delivered 68,500 hepatitis A vaccination doses, including 53,869 to those considered at-risk — homeless residents, drug users and those with liver diseases and compromised immune systems.

As of last Saturday, Wooten said 501 “foot team” missions have been conducted, taking the vaccination effort to sidewalks, street corners and riverbeds where many who are at risk sleep and socialize.

Dr. Nick Yphantides, the county’s chief medical officer, took a moment at Tuesday’s meeting to debunk what he said has become belief among some in the public that the outbreak is being caused by tainted water near where homeless are camped.

“There (are) absolutely no established cases that are isolated to be associated with any water sources in the outbreak,” Yphantides said.

The county’s vaccination efforts, which have been bolstered by sanitation improvements from hand washing stations to periodic sidewalk cleaning, are about to enter a new phase.

Dr. Robert Schooley, chief of the Division of Infectious Diseases at UC San Diego School of Medicine, said Tuesday that his organization, and other local health providers, are gearing up for a big outreach effort in San Diego’s many single-room-occupancy hotels.

“We’re trying to figure out how best to configure the teams and to interact with the folks who run these facilities so that we’re efficient and not intrusive,” Schooley said.

The San Diego Housing Commission’s current list of single-occupancy hotels in the city includes 101 different properties with 5,068 rooms. Capacity ranges from the seven-room Gibraltar Lodge on Clay Avenue to the 325-room Golden West Hotel on 4th Avenue downtown.

These properties tend to rent one room per individual at prices far below the cost of an apartment. They often have shared bathroom facilities.

It was not clear Tuesday when the additional vaccination efforts might start. County health officials did not respond to requests for more information on the effort or on the overall trend in local case counts.

For the first time in many months, the number of new cases and hospitalizations added to overall totals rose by less than 10. Last week, by comparison, those same counts jumped by more than 20 in a week.

Does this mean that the outbreak is losing steam?

Wooten told the supervisors Tuesday that about 20 new cases per week were reported from May through August but, more recently, the trend has been “two to three per day.”

If the current new-case rate is closer to two per day than three then that would seem to indicate that the outbreak’s spread is slowing a bit. Health department officials did not respond Tuesday to a request for more information.

Schooley, the UC San Diego infectious disease chief, said the outbreak is not currently producing the level of urgency that it did a few months ago.

“It does look as if things are not increasing as rapidly as they were in the spring. Over the last number of weeks things seem to be stabilizing,” Schooley said.

But he cautioned that, especially with a disease that has a five- to 50-day incubation period, it’s too soon to make definitive statements about the outbreak.

“While the trends we’ve seen are very good, it’s too early to say we’re seeing an end,” Schooley said.

UC San Diego hospitals had treated 115 hepatitis A patients, including seven who died, as of Sept. 22.

Wooten told the board that there were still 47 suspected cases under investigation, the same number that a county official cited last week.

Because it takes weeks for the CDC to confirm that each case was caused by the same hepatitis A strains identified in the county’s outbreak, the official number of confirmed cases always lags behind preliminary totals.

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paul.sisson@sduniontribune.com

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