Last summer, health officials in San Diego County noticed an increase in people suffering from nausea, diarrhea, jaundice, and fatigue. Hepatitis A, a viral liver disease, was spreading fast — particularly in communities of homeless individuals, and among those with compromised systems. By early September, the county’s public health office declared an emergency, as patients flooded hospitals. Four weeks later, 461 known cases had been reported, 315 people had been hospitalized, and 17 had died — all within the span of 10 months. The numbers continue to rise.
Dr. Wilma Wooten, director of public health services for the San Diego County Health & Human Services Agency, says it’s an unprecedented outbreak. “This is new territory,” she told Kaiser Health News.
Since 2005, Hepatitis A has been included nationally in the general vaccine package for kids, with most receiving their first dose at 12 months, and their second six months later. It’s also frequently administered before people travel abroad.
But in this case, the disease’s victims don’t receive the regular medical care that could prevent its spread. In Southern California, those falling ill are disproportionately unhoused; 65 percent of people with hepatitis A in San Diego County were experiencing homelessness. And the problem is spreading: Los Angeles County has seen 12 cases in recent weeks and has taken on the task of preventing the disease from reaching more. By late September, health officials had vaccinated 1,200 of the estimated 57,000 people living on L.A.’s streets.
Watching Southern California struggle with hepatitis A spurred San Francisco into action. The Centers for Disease Control sent San Francisco 1,700 hepatitis A vaccines through its 317 fund, which is reserved specifically for outbreak prevention. Rachael Kagan, spokesperson for the city’s Department of Public Health, says there is no outbreak in San Francisco at this time. But prevention is key. Tenderloin Health Services, a program of HealthRIGHT 360 and a recipient of some of the hepatitis A vaccines, prepared two clinics specifically focused on inoculating those at high risk.
Dr. Andrew Desruisseau, the THS’s medical director, tells SF Weekly that there are a number of groups who are susceptible to catching the disease — such as people living without homes who don’t have access to clean water, soap, and other hygienic tools; those who inject drugs; and anyone who comes into frequent contact with these populations, such as health-care or shelter workers.
Homeless camps where people live in close proximity to one another can exacerbate the situation.
“With the city’s gentrification, people are being squeezed into tighter areas,” Desruisseau explains. “We see that in the Tenderloin — it seems like there’s a lot more homeless people, but really, they’ve been pushed out of other places.”
Part of the problem in preventing the disease, he says, is that it has an extensive incubation period, ranging from 15 to 50 days.
“If I were exposed today, it might be four weeks before I get sick,” Desruisseau says. “Like many diseases, something that might not get you sick right away isn’t something that people get concerned about.”
But Desruisseau and Tenderloin Health Services have an added advantage to reaching those populations who are at high risk: They’re located in the same building as GLIDE, which serves around 2,400 free meals per day in its dining room. Conducting outreach at all levels of the organization, they have combined hepatitis A shots with a flu vaccine clinic.
“We’re trying to reach the highest risk, the homeless, the I.V. drug users, the chronically ill,” Desruisseau explains.
But the event is not all doom-and-gloom.
“We have a DJ, we have food,” he says. “It has to be fun, right? These sorts of events are only as successful as we are enthusiastic. If we can be super engaging and talking up why it’s important we’ll be more successful.”
At Friday’s clinic, around 40 people were vaccinated. This Friday, Desruisseau hopes to treat more. But as much of the city’s at-risk constituents are being pushed to the edges of the city, under highways and down dead-end roads, keeping the disease at bay will be an ongoing effort.
The next free hepatitis A vaccination clinic will take place on Friday, Oct. 6 from 1-4 p.m. at Tenderloin Health Services, 330 Ellis St.