As San Diego County health officials work to combat a hepatitis A outbreak that has killed 16 people and sent more than 300 to the hospital, public health officials in Los Angeles and Orange counties say they're taking steps to prevent the virus from spreading northward.
"We are very concerned about an outbreak" given the extensive travel between San Diego and Los Angeles, said Dr. Sharon Balter, director of the L.A. County Department of Public Health's acute communicable disease control program.
The San Diego outbreak, which has infected more than 400 people, has spread primarily among homeless people and illicit drug users. People who provide services to these populations have also been infected.
Vaccinating homeless people and their service providers is critical to preventing the outbreak from spreading, said officials in Orange and L.A. counties.
In Orange County, public health nurses are encouraging homeless people to get vaccinated through their primary medical providers and administering vaccinations at shelter clinics, food pantries and parks. More than 300 people have been vaccinated so far, according to the Orange County Health Care Agency.
L.A. County public health officials said they have vaccinated more than 1,000 people to date.
Officials in both counties are also educating service providers and shelter employees about how to spot and prevent hepatitis A.
"The important thing to let people know is that it is very, very important to wash your hands after you go to the bathroom and before you eat, and to maintain good sanitation if that's possible," Balter said.
Hepatitis A is a highly contagious liver infection caused by a virus. It's usually transmitted through contaminated food or water. It can cause liver disease, lasting a few weeks to months. In some cases, it can be fatal.
The disease can cause fever, fatigue, nausea, loss of appetite, jaundice, stomach pain, vomiting, dark urine, pale stools and diarrhea. Some of those infected don't develop symptoms.
In San Diego, county nurses and health care providers have provided hepatitis A vaccinations to more than 21,000 people since the outbreak began, said Craig Sturak, spokesman for the San Diego County Health & Human Services Agency.
San Diego officials are also spraying sidewalks with bleach-infused water and have installed 43 hand-washing stations in areas where the homeless congregate, he said.
There have been 38 cases of hepatitis A in L.A. County so far this year, and none on Skid Row, according to the county Department of Public Health. At least a few of those who got sick were infected in San Diego, Balter said.
Over the last five years, there were between 34 and 60 cases annually in L.A. County.
There have been 13 cases of hepatitis A in Orange County so far this year, according to the Health Care Agency. Of those, one had a history of homelessness and contracted the virus after spending time in San Diego. That individual's symptoms have since resolved.
There were between 15 and 25 cases of hepatitis A reported annually in Orange County between 2012 and 2016.