City officials proactive as Hepatitis A spreads to Chula Vista

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Downtown San Diego remains the center of the county’s Hepatitis A outbreak, but Chula Vista

city officials and Southwestern College health services professionals said they are working proactively to prevent an epidemic in the South Bay.

As of December 1, San Diego County had logged 561 cases of Hepatitis A over a 12-month period, primarily among the burgeoning homeless population in the East Village and the Newton Avenue area of San Diego. Of those, 378 people were hospitalized and 20 died. Chula Vista has had 17 confirmed Hepatitis A cases over the past year, most among its homeless population in the Third Avenue and Memorial Park area. Southwestern College is within seven miles of the San Diego outbreak area and about three miles from the Chula Vista areas.

College health services employees have not reported any student cases, but college leaders said they are concerned about the Hepatitis A situation in Chula Vista because thousands of students live, work or take public transportation in the affected areas. Local doctors are urging SWC students and employees to be vaccinated against the disease.

San Diego’s Hepatitis A outbreak has become national news and a growing concern at the Center for Disease Control in Atlanta. A Hepatitis A case in Phoenix was traced to San Diego and CDC officials expressed concern that people in other cities may be infected by people traveling from San Diego County. Los Angeles officials are initiating Hepatitis A containment strategies as are other Southern California cities with homeless populations.

SWC has hosted a pair of events this semester that offered screening for Hepatitis A as well as free vaccinations. Campus student services employees are also reaching out to known homeless students to brief them about the Hepatitis A situation and to steer them toward health services and vaccinations.

(Campus Nurse Grace Cruz was uncooperative and refused multiple requests for interviews. She told reporters who visited her office that she had given written questions directed to her that she had requested to the college communication staff to answer.)

Marlon King, the Emergency Services Coordinator for the City of Chula Vista, said city employees at risk of exposure to the disease have been vaccinated or encouraged to get vaccinations. These employees include police officers, fire fighters, paramedics, public works crews and janitorial personnel, King said.

Chula Vista has embarked on a program of systematic power washing of restrooms in city parks, King said. Emergency Services personnel have placed 15 handwashing stations provided by the County Health Services Department in high risk areas throughout the city, he said, in an effort to slow the spread of the disease. Improper handwashing after using the restroom is a primary cause of Hepatitis A, he said.

Restaurant employees can also spread the disease if they do not practice proper hygiene, King said. All Chula Vista restaurants and businesses have been sent educational materials focusing on Hepatitis A, its spread and prevention.

“We want to make sure they are practicing sanitation techniques,” he said. “We do not want this to get into food because it could then become an uncontrollable outbreak.”

Chula Vista’s Homeless Outreach Team (HOT) is working with doctors and nurses from County Heath to offer free vaccinations to at-risk homeless people in the city, according to Chula Vista Police Sgt. Frank Giame.

“Homeless are the most vulnerable population and this is probably where the outbreak stemmed from,” he said. “We have vaccinated a good portion of that population and we will continue to do that.”

Giame said the CV Public Works Department has been using a bleach solution to power wash public restrooms in parks and some other areas where homeless people have congregated. He said local hospitals will treat anyone with Hepatitis A.

Chula Vista’s Third Avenue has enjoyed a Renaissance of redevelopment over the last decade, with new restaurants, brew pubs and other trendy gathering spots. It has, ironically, also experienced an increase in homeless people sleeping in the doorways of 9-5 businesses after they close for the evening. City officials have said the Chula Vista homeless situation may be spillover from the San Diego homeless communities that have suffered from violence, harassment and police sweeps to move them out of certain areas. Chula Vista and National City have long-established homeless encampments in the bed of the Sweetwater River that runs through both cities. There are also smaller homeless encampments in the riverbed in eastern Sunnyside and into Spring Valley. Earlier this year County Public Works crews removed several trash bins full of garbage from the river when winter rains washed refuse from the encampments where it snagged on bridges and arundo donax cane plants downstream.

Dr. Wilma Wooten, San Diego County Public Health Officer, said most of the people who have contracted Hepatitis A during the outbreak have been homeless or illicit intravenous drug users. She said the outbreak is being transmitted person-to-person and through contact with “fecally contaminated environments.” Symptoms can develop 15-50 days after exposure, though some people do not immediately demonstrate any symptoms. Hepatitis A can cause jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, dark urine and pale stools.

Hepatitis A has been nearly eliminated in the United States since a vaccine was introduced in 1995. CDC records show fewer than 2,500 cases in the U.S. last year, about one in five from San Diego County.

Wooten’s teams have staged almost 1,700 field vaccination events, more than 23,000 field vaccinations and more 106,000 total vaccinations administered, according to county records.

In October, the El Cajon City Council passed an emergency ordinance that bans food distribution to the homeless on any city-owned property, obstensibly to protect residents from the virus. El Cajon officials said the ban will help to prevent the spreading of virus among the homeless, who received weekly food donations from volunteers. Activists and volunteers gathered at Wells Park in El Cajon on November 19 to protest the ban, handing out lunch bags with food and personal items.

King said the city of Chula Vista is taking a more compassionate approach through vaccination, sanitation and education. City policy is not to criminalize homelessness, but rather to offer services and support to people living in streets, parks and the riverbed. Police officers are directed to help law-abiding homeless people.

The San Diego County Board of Supervisors extended the local Hepatitis A health emergency into December.

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