Los Angeles County Declares Hepatitis A Outbreak

Los Angeles County has announced a widespread outbreak of hepatitis A, which is a contagious viral illness that can cause significant liver damage and even result in death.

While hepatitis A cases have been part of the region’s landscape before, health officials are increasingly worried about its rising occurrence and the demographic of those being infected.

In 2024, there have been 165 reported cases, which is three times greater than the previous year and represents the highest number in the county over the past decade. Tragically, seven deaths have been attributed to an outbreak that has now spanned 13 months.

Traditionally, hepatitis A outbreaks in L.A. County have been linked to homeless individuals, as the lack of access to sanitation facilities facilitates the spread of the virus. However, this year’s reports indicate that a majority of those infected are not homeless and have neither traveled recently nor engaged in drug use, which are typical risk factors.

“The alarming rise in hepatitis A cases shows that immediate action is essential for public safety,” stated Dr. Muntu Davis, L.A. County’s health officer, who is encouraging vaccination.

In the first quarter of this year alone, there have already been 29 cases reported, which is double the figure from the same period last year.

The virus is highly contagious and can be found in the feces and blood of infected individuals; it can spread through contaminated food and drinks. Other common infection routes include drug use, caregiving, or sexual contact with someone who is infected, according to the U.S. Centers for Disease Control and Prevention (CDC).

Many actual cases may not be recorded, suggesting the figures the county currently has could significantly underestimate the outbreak’s true extent. The ongoing outbreak has already exceeded L.A. County’s last notable surge in 2017, which had 87 confirmed cases.

“We suspect the outbreak is more extensive than our numbers suggest,” remarked Dr. Sharon Balter, director of the Los Angeles County Division of Communicable Disease Control and Prevention. She stressed that healthcare providers should consider testing for hepatitis A when patients exhibit relevant symptoms.

Recent wastewater data has also indicated the outbreak’s presence, Balter noted. While there was hope last year that a decrease in viral levels signified a decline, levels have begun to rise again.

Wastewater monitoring provides a clearer perspective on the virus’s community prevalence, as “many people may not seek medical attention when infected,” either due to being asymptomatic or lacking healthcare access, Balter explained.

Symptoms of hepatitis A can include fever, fatigue, abdominal pain, nausea, yellowing of the skin or eyes, and dark urine. While most adults manifest symptoms upon infection, over 70% may experience jaundice. In contrast, around 70% of infections in children under 6 are symptomless.

A majority of individuals will recover from the virus, but it can sometimes lead to serious liver complications or death, Balter cautioned.

Genetic evaluations show that the strain involved in this outbreak is primarily circulating within L.A. County, according to Dr. Prabhu Gounder from the L.A. County Department of Public Health’s viral hepatitis unit. A few cases associated with this strain have also been recorded in nearby Orange and San Bernardino counties.

The hepatitis A vaccine has been recommended by the CDC since 1996 for young children in high-prevalence areas and since 2006 for all children.

“This vaccine is highly effective,” Gounder noted.

The CDC advises that all children should receive the hepatitis A vaccination at ages 1 or 2, through a two-dose schedule spaced at least six months apart. Older kids and adults are also eligible for the vaccine.

Interestingly, vaccination against hepatitis A has not been mandated for entry into California’s kindergartens or childcare centers.

“This implies a large population of adults who might not have been vaccinated,” Balter explained.

Due to the outbreak, the L.A. County Department of Public Health strongly recommends hepatitis A vaccinations for:

• L.A. County residents who haven’t been vaccinated and are looking for protection
• Individuals facing homelessness
• People who use drugs, including non-injection types

“It’s a very safe and effective vaccine. You can get it through your healthcare provider or simply at a pharmacy,” Balter added. Millions of doses have been administered since the 1990s, according to the CDC.

Especially vulnerable groups, such as those who are homeless or engage in drug use, “should definitely get vaccinated,” Balter stressed.

If you are uncertain about your vaccination status, it is still advisable to get the shot, even if it may mean getting vaccinated again.

“If you’re unsure, just go ahead and get the vaccine,” Balter recommended.

If you have received both doses, additional shots are generally unnecessary, except for specific cases, like bone marrow transplant patients who may require re-vaccination.

Another important protective measure is regular handwashing with soap and water, particularly after using the restroom or before preparing food, emphasized Balter.

“When using hand sanitizer, ensure it has at least 60% alcohol; many don’t meet this requirement,” she pointed out, as lower concentrations may not effectively eliminate the virus.

There can be a period of 15 to 50 days between being exposed and showing illness, according to the CDC. Mild cases might last one to two weeks, whereas severe ailments can persist for several months. Approximately 10% to 15% of infected individuals may experience ongoing or recurring symptoms for six to nine months.

Due to the virus’s long incubation period, “we need to take preemptive action,” Gounder warned. “Currently, we’re experiencing cases linked to exposures from several weeks ago.”

Diagnosing hepatitis A can be trickier, as early symptoms are often confused with gastroenteritis. More obvious symptoms, like jaundice, may appear later, potentially after negative test results for the virus.

Records indicate that diseases similar to hepatitis A have existed since ancient times, but the virus itself was only isolated in the 1970s. It was more prevalent prior to the introduction of an effective vaccine in the U.S. in 1995.

Hepatitis A case rates declined sharply from 1996 to 2011, dropping by 95.5%. Unfortunately, a resurgence has been noted since 2016, driven by outbreaks among those using drugs and the homeless population.

San Diego County was notably impacted during a significant outbreak that resulted in 20 deaths and 592 cases between 2016 and 2018.

The 2017 hepatitis A outbreak in L.A. County “ended due to a substantial public health effort to provide vaccines to those without access, along with heightened awareness of the illness,” Balter recalled.

Of the 165 hepatitis A cases reported last year, most were among adults who likely hadn’t been vaccinated as children for various reasons, according to officials.

Monitoring wastewater to gauge the outbreak’s scale has proven helpful, though officials worry that potential federal budget cuts could impair such services.

“We’re genuinely concerned about the effects of reduced federal funding on our capability to shield L.A. County from outbreaks like hepatitis A,” Balter affirmed.

A recently proposed federal budget could significantly diminish or eliminate several grants that support vital public health initiatives, Balter noted.

“Such cuts would greatly hinder our ability to track and respond to illnesses,” she expressed concern.

Another pressing issue is the risk of decreased funding for vaccines. “If funds are slashed, we would lose a crucial source of free vaccines necessary to boost community immunity, which is ultimately essential to halt this outbreak,” Gounder concluded.