By: James Peacock

Hepatitis A has made headlines recently in California, as San Diego has been reporting higher than normal incidence rates of Hepatitis A in the area. Now, reports out of Santa Cruz have also indicated that quite a few more cases than usual are being diagnosed in that area. Health officials have yet to find a source of these infections but are looking for common foods, drinks, or habits shared by those who have been infected. Recently, health officials have expressed concern that the two outbreaks may be connected – citing that it appears that the same strain of Hepatitis A is present in both outbreaks. Vaccination services have been offered in both cities, and health officials urge anyone who has not already gotten the Hepatitis A vaccination to receive one as soon as possible.

San Diego

San Diego began to see a rise in Hepatitis A incidence in November 2016. By the time of the first press release in April 2017, 42 people had been diagnosed with Hepatitis A. This amount of people is four times as many than what is typically reported. At the time, 36 people out of the 42 people needed to be hospitalized for their illnesses, and there had been two deaths reported. At the time, health investigators learned that 27 of the people sickened were homeless, and 29 had a history of substance abuse. Five of those sickened had traveled outside of the United States prior to becoming ill.

An update to the San Diego outbreak was provided about a month later, in early May. By that point, the number of cases had risen to 80 people. One more death had been reported as well. Sixty-six out of 80 people had been hospitalized because of their illnesses. Health investigators at that point still searched for a source – as they had been unable to find a common food, drink, or drug that could have caused the outbreak. This update also reported that there had been seven cases of Hepatitis A poisoning linked to local detention centers. Potential exposures to the virus took place at the George Bailey Detention Facility, San Diego Central Jail, and Vista Detention Facility. The exposures likely took place in late March and early April.

The most recent update given by San Diego County took place on June 12, 2017. The amount of Hepatitis A cases had doubled since the last update, bringing the grand total to 160 cases of illness. Out of these 160, 120 people needed to be hospitalized because of their illness. Four people have now died because of the outbreak. Health investigators have still not been able to find the source of the outbreak, but did reiterate that the majority of those sickened are either homeless or illicit drug users. There have now been 12 cases of illness connected to exposures in local jails. The George Bailey Detention Facility, the San Diego Central Jail, and the East Mesa Detention Facility are all connected to potential Hepatitis A exposures. Potential Hepatitis exposures continued throughout April and into early May.

Santa Cruz

The Santa Cruz County Health Services Agency also recently reported that they were tracking an increased amount of Hepatitis A infections. Since late April, there have been nine confirmed cases of Hepatitis A poisoning. This is quite an increase over the average, as Santa Cruz County usually reports one or two cases per year. Like in San Diego, most of the people affected by this outbreak are homeless, users of illicit drugs, or have dense living conditions. To help combat the increasing amounts of Hepatitis A infections, county health officials have set up clinics throughout the area in an effort to distribute vaccines to as many people as possible. A list of immunization centers in the area can be found here.

Previous Hepatitis A Recalls and Outbreaks

Though typically seen as a rarer form of foodborne illness, Hepatitis A has caused a few major outbreaks and recalls recently. Last July, it was reported that a Hepatitis A outbreak was taking place on several of the Hawaiian Islands. That investigation would eventually go on for about 6 months. The source of the outbreaks was later discovered to be scallops imported from the Philippines. When the outbreak was first announced, there were only 30 people sickened. By December, though, that number had grown to over 290 people. The raw scallops connected to the outbreak were served at quite a few restaurants on the islands, but the outbreak remained largely centered on the island of Oahu. It was also uncovered over the course of the investigation that employees infected with the Hepatitis A virus were still attending work while ill. Because these employees worked at a variety of restaurants, health officials became concerned that the outbreak may become more widespread. The rate of new infections would eventually slow to a stop thanks to an embargo on the contaminated scallops.

On the other side of the nation, the CDC began to receive reports of Hepatitis A infections from Virginia and the surrounding states. In September of 2016, the CDC announced that they were investigating a nationwide outbreak, with Hepatitis A infection popping up in California, Wisconsin, Oregon, Arkansas, New York, Virginia, West Virginia, Maryland, and North Carolina. In the month prior to the announcement, Tropical Smoothie Café announced that smoothies containing strawberries had been linked to Hepatitis infections. The contaminated strawberries were subsequently removed from stores, and it was eventually learned that the strawberries had been imported from Egypt. Despite assurances from the company that the strawberries were uncontaminated, the FDA was able to isolate Hepatitis A from a sample taken from the strawberries.  Over the course of the outbreak investigation, which lasted until mid-December 2016, 143 people would report being ill in the nine states listed above. Fifty-six people would need to be hospitalized because of their illnesses.

In May of this year, a recall of imported tuna products was caused by a Hepatitis A contamination. At first, it was reported that the tuna, recalled by PT Deho Canning Co., was distributed to retailers on the Hawaiian Island of Oahu. The tuna products were sold without going through the inspection process. Testing done after some of the product was sold revealed the potential contamination. Two weeks after the initial recall, Hilo Fish Company notified the FDA that potentially contaminated tuna might have been sold to distributors and retailers on the mainland United States. A second recall was issued, this time for tuna products sold in California, Texas, and Oklahoma. Contaminated tuna was also sent to New York, but health officials managed to catch that tuna prior to it being sold to consumers.

Hepatitis A

Hepatitis A can be a very serious foodborne infection of the liver, but an infection can largely be avoided. Proper hygiene, including the thorough washing of hands, is an important step in halting the spread of all infections, not just Hepatitis A. By following other food safety techniques, many foodborne illness infections can be prevented. Even with all of these measures, though, by far the best way to prevent a Hepatitis A infection is through getting a vaccination. The Hepatitis A vaccine, first offered in 1995, is recommended by the CDC for all adults and children over the age of one. The vaccine works by introducing inactivate Hepatitis A virus to a person’s body in order to spur the creation of antibodies. Antibodies are the body’s natural immune response to the presence of the virus, and they work to identify a specific virus in the bloodstream. When a potential virus is identified in the bloodstream by antibodies, the immune system is activated to destroy the virus. The Hepatitis A vaccine can provide resistance to the virus for up to 25 years. Hepatitis A antibodies also appear if Hepatitis A infects someone. The vaccine has led to an exponential reduction in the amount of Hepatitis A infections. In 1989, health officials reported almost 40,000 cases of Hepatitis A, but today the CDC estimates that there are less than 5,000 cases of Hepatitis A per year. Again, the CDC recommends that all children and adults over the age of one receive the vaccination, as well as those traveling to areas with high incidence rates of Hepatitis A, those working in hospital and research facilities, and those with chronic liver diseases.

Hepatitis A infections may not produce symptoms in those it infects. Whether or not symptoms appear usually depends on the age of the victim. Adults and children over the age of six will present the typical symptoms of a Hepatitis A infection, and 70% of these cases present with jaundice, or yellowing of the skin and eyes. Asymptomatic cases of Hepatitis A are most common in children under the age of six. About 70% of cases in young children do not produce any symptoms. A case of Hepatitis A poisoning will abruptly produce symptoms in as soon as 15 days after infection, although it may take up to 50 days. The CDC reports that a Hepatitis A infection will produce symptoms after 28 days, on average. The Hepatitis A virus targets the liver, and because of this will typically cause symptoms including fever, vomiting, joint pain, nausea, clay-colored bowel movements, loss of appetite, dark urine, fatigue, abdominal pain, and jaundice. Although the symptoms will usually last for about 2 months, the CDC has said that there is a 10 to 15% chance of relapsing within 6 months. There is no risk of the infection becoming chronic. If you or a loved one begins to show the symptoms of a Hepatitis A infection, contact a medical professional.