SAN DIEGO (AP) — San Diego County health authorities have declared an end to an outbreak of hepatitis A that began two years ago, killed 20 people and sickened nearly 600.
Public health officer Dr. Wilma Wooten said that Oct. 25 marked 100 days since the most recent case, the threshold for no longer meeting the definition of an outbreak, the San Diego Union-Tribune reported Tuesday.
San Diego has had only 15 new cases in 2018.
Local health authorities detected the infectious disease in February 2017. Investigators determined the first likely case occurred during the week of Nov. 22, 2016.
The outbreak led to a focus on unsanitary living conditions among San Diego’s homeless population.
City and county governments promoted vaccination, washed streets, installed portable toilets and hand-washing stations, and put up temporary shelters capable of housing 700 people at a time.
The cost of fighting the outbreak was estimated at more than $12 million, the Union-Tribune reported.
The expense was what was needed to address years of deferred attention to the homelessness problem, said Bob McElroy, chief executive of Alpha Project, one of several organizations operating new shelters.
“The reality is, if you’ve got a place for people to be safe and have access to health care, you’re just not going to have the kinds of sanitation issues you have with tent cities lining the streets,” McElroy said.
Dr. Jonathan Fielding, distinguished professor of the UCLA Fielding School of Public Health, applauded San Diego’s willingness to spend the necessary money.
“Hepatitis A is very contagious,” Fielding said. “Getting something like this under control, it takes money, it takes an enlightened bureaucracy and it takes a heck of a lot of coordination. It’s clear that you have that in San Diego.”
The need for resources and cleanliness does not end just because the outbreak is over, he said.
Wooten, the public health officer, said the mobile vaccination “foot teams” of public health nurses accompanied by law enforcement officers that the county started sending into homeless encampments are now a standard tool for use when needed.
A key lesson from the outbreak was that it often took months to convince at-risk homeless people to accept vaccination that they viewed as a government conspiracy, Wooten said.
“But we knew it would take time for this population to trust us, and we had to just keep going back and engaging in order to build that trust,” she said.
Hepatitis A outbreaks continue elsewhere in the nation, including Michigan, where it dates to August 2016.