Message from the Interim Health Officer for Los Angeles County
Jeffrey Gunzenhauser, MD, MPH
October 3, 2017
On September 19, 2017, the Los Angeles County Department of Public Health declared a local outbreak of hepatitis A occurring among persons who are homeless or actively use drugs. The declaration was based on the discovery of cases among individuals who appear to have acquired the infection within Los Angeles County. As of late September, Public Health has identified a total of 12 cases in Los Angeles County associated with this outbreak. Many of these cases had direct links with outbreaks in other counties. The most recent cases had no known links with other cases, suggesting that transmission may be occurring within our County.
The outbreak in Los Angeles County follows on the heels of much larger outbreaks that have been on-going in San Diego and Santa Cruz counties and are largely restricted to persons who are homeless or use drugs. Prior to the declaration of the outbreak in Los Angeles County, the Department of Public Health had been preparing for this possibility, given our proximity to San Diego and Santa Cruz counties. As cases have been identified, Public Health has worked with a variety of health care providers and community partners to conduct rapid investigations and ensure that all contacts receive appropriate treatment and follow-up. Now that a local outbreak has been declared, efforts to protect all persons who might be at-risk have become an even greater priority. Public Health is conducting active outreach to shelters, feeding centers, and other locations and working with a wide range of service providers to vaccinate persons who are homeless or use drugs, as well as other persons who might be at risk.
What is Hepatitis A and How is it Spread?
Hepatitis A is a highly contagious liver infection that is caused by a virus. Symptoms may include fever, fatigue, nausea, loss of appetite, stomach pain, vomiting, dark urine, pale stools, diarrhea, and yellowing of the skin or eyes (jaundice). Some people may not have any of these symptoms even though they are infected with hepatitis A. In some persons the illness can last for weeks or even months. Among individuals with pre-existing liver disease or other serious health problems, the illness can be severe, possibly leading to death.
Hepatitis A is spread from person-to-person through what is called the “fecal-oral” route. Persons who are infected excrete the virus in their stool. Other persons become infected by ingesting food or other material that has been contaminated with fecal material from an infected person. This is why hand-washing after using the bathroom or before eating food is so important. The ways in which hepatitis A is spread from one person to another include:
Hepatitis A-infected individuals can spread the infection for two weeks before they exhibit symptoms. Once they have symptoms, they may spread the virus for another week. Some people will not have symptoms but can still pass the virus to someone else. Once someone fully recovers, they are immune and protected against ever getting the infection again.
Who is Most at Risk for Acquiring Hepatitis A?
Anyone can get infected with hepatitis A. However, in the current situation, those who are at-risk are limited to specific groups. These include persons who:
Hepatitis A Treatment
There is no specific treatment for hepatitis A infection. Most people will recover completely and, while they are ill, should rest, stay hydrated, eat nutritious foods, and be under the care of a doctor. However, those who become very ill may need to be hospitalized. Patients who are over 50 years of age, have underlying medical conditions or weakened immune systems are at greatest risk for severe illness. This is why it is very important to seek medical care if you experience the symptoms of hepatitis A.
Hepatitis A Prevention
The hepatitis A vaccine is the best way to prevent hepatitis A infection. This vaccine has been licensed for use in the United States since 1995. Most persons in Los Angeles County who were born in 1998 or later received the vaccine as children and are protected against this infection. The vaccine series consists of two shots, given six months apart. A single dose is highly effective in providing protection in adults, and there is no harm in getting the vaccine if you may have received it before.
Persons who are at-risk for infection as a result of the work they do can often receive the vaccine from their employer. Vaccine can also be obtained from a person’s primary care provider. Some pharmacies may also offer the vaccine. Persons who are at-risk for hepatitis A infection and who are not able to receive the vaccine from other sources, may get the vaccine at the Department of Public Health’s clinics. Extended hours are offered at some of these clinics. For more information on where to get the vaccine, call Los Angeles County’s 2-1-1 phone line.
Additional important steps to prevent hepatitis A infection include the following:
Additional Hepatitis A Resources
The Department of Public Health’s hepatitis A web page has extensive information for the public including health education materials in multiple languages. Information specific to clinicians, such as how to report suspect cases of hepatitis A, is available on the Department’s Acute Communicable Disease Control hepatitis A web page.
03/24/17 - Every year, World TB Day is celebrated on March 24th to commemorate the day in 1882 that Dr. Robert Koch discovered the bacteria Mycobacterium tuberculosis and identified it as the cause of the disease tuberculosis (TB). Text
02/01/17 - We are now in the middle of the 2016-2017 flu season. A sharp increase in the number of cases has been seen throughout California, and more recently in Southern California. Even though the flu season is underway, it is still not too late to get the vaccine. Text
12/23/16 - Families often travel during the holidays to visit relatives or go on a vacation out of town. These trips are great opportunities to unplug from daily life, spend quality time together with family, and share new experiences. Text
11/09/16 - Sexually transmitted diseases (STDs) are the most commonly reported communicable diseases and rates are rising in the United States, California and Los Angeles County (LAC). In LAC, there were nearly 75,000 STD cases reported to the Department of Public Health (DPH) in 2015. Text
8/12/16 - Climate change is a source of concern for many, especially as warmer, drier weather is observed throughout the county. This affects us in many ways. While the mild El Niño season helped fill many of California’s reservoirs, water is still a major concern. We continue to experience record-breaking temperatures. In addition, in the past few weeks, a number of fires have caused many square miles of brush and property to burn. Text
In the last two months, 7 cases of invasive meningococcal disease have been reported within the Los Angeles County Public Health jurisdiction. Additional cases have been reported in surrounding jurisdictions.
June 27th is National HIV Testing Day. The day is a great reminder to get tested for people who don’t know their HIV status or who may have been exposed to HIV since their last test.
Alcohol is a huge continuing problem that affects many lives and can tear families apart. Alcohol is also the
second leading cause of premature death and disability in Los Angeles County, contributing to more than 1000 deaths every year
There has been a lot of information on Zika in the news lately. Below are some ways we can address this disease to keep our friends and family safe, and to prevent Zika transmission in our County.
January is Cervical Health Awareness Month. It’s a great time to learn more about cervical cancer and ways to prevent this disease from affecting family and friends.
I would like to wish everyone a happy and healthy holiday season! I hope many of you are able to spend time with family and friends while enjoying and sharing your cultural traditions. To help you and your loved ones celebrate safely over the next few weeks, here are some tips and guidelines to keep in mind:
November 16-22, 2015 is Get Smart Week. The goal of Get Smart Week is to raise awareness about antibiotic resistance.
The 2015-2016 influenza season has started. Make sure you and your family are protected! Get your influenza vaccine now. Influenza, or the flu, is a virus that causes mild to serious illness.
Prescription drugs play a critical role in treating
people when they are sick or feel pain. It is also
very important to properly dispose of all unused or
expired medications. Unused medication can pose a
major health and safety risk if left in the home.
08/10/15 - Last Thursday the California Department of Public Health (CDPH)
announced a case of human plague in California. The patient lives in LA County and was hospitalized for the illness after a family trip to Yosemite State National Park and Stanislaus National Forest. Officials are still investigating where the individual may have contracted the disease.
07/06/15 - I am happy to report that new Ebola cases in West Africa have significantly declined due to the extraordinary efforts by healthcare professionals to care for infected individuals and reduce community transmission. The number of new weekly cases in West Africa has remained below 30 for several weeks and efforts remain strong to bring the epidemic to a closure as soon as possible.
04/22/15 - Progress continues to be made as the world responds to the Ebola epidemic in West Africa. Although the situation has improved greatly and the weekly number of new cases has fallen well below 100, we must remain vigilant until the number of new cases in affected countries reaches zero. Here in Los Angeles County, we continue to closely monitor individuals who travel here from affected countries and who may be at risk of developing Ebola.
03/17/15 - The world response to the Ebola epidemic in West Africa has decreased the number of new cases occurring there and there is hope that the epidemic can be stopped sometime this year. Here in Los Angeles County, we continue to closely monitor individuals who travel here from affected countries and who may be at risk of developing Ebola. We maintain our surveillance and actively monitor a small number of travelers each day who have
11/24/14 - Earlier this week the Centers for Disease Control and Prevention (CDC) added Mali to the list of Ebola-affected countries, which continues to include Guinea, Liberia, and Sierra Leone. To date, more than 15,000 individuals have contracted Ebola during this latest epidemic and there have been 5,420 related deaths worldwide. In the United States, a second Ebola-related death occurred last Monday after Dr. Martin Salia was transferred to Nebraska Medical Center from Sierra Leone for medical care following several days of illness. His tragic passing highlights the critical importance of early intervention and care in recovery.
11/17/14 - Ebola outbreaks continue to affect Guinea, Liberia, and Sierra Leone in West Africa with some new cases reported in Mali. While the rate of new cases in Liberia and Guinea has leveled off, the rate of rise in Sierra Leone continues to accelerate. To date, approximately 14, 000 individuals have contracted Ebola during this latest epidemic and there have been 5,160 related deaths worldwide. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) will continue to monitor the situation and coordinate relief efforts to control the spread of infection. It is important to note that only two cases of Ebola have been exported from West Africa to other parts of the world, which is a testament to the effectiveness of the strategies that are in place to prevent spread. Those two cases are, of course, the case that was diagnosed in Dallas on September 30, and the more recent case in a physician in New York City who has recovered and been released.
11/10/14 - The Department of Public Health continues to coordinate efforts to ensure we have an effective strategy to respond to a potential case of Ebola in LA County. As part of these ongoing efforts, we met last week with the Hospital Association of Southern California and the California Association for Health Facilities. The meetings were held jointly with LA County Emergency Medical Services and provided hospitals and long-term health care facilities with an update on Ebola, our current activities, and response plans for LA County. Each meeting was an opportunity to strengthen partnerships and facilitate coordination with all health care providers who may play a role in identifying and treating an individual with Ebola.
11/4/14 - The State Health Officer from the California Department of Public Health recently issued a risk-based quarantine order for any individuals coming into California who had contact with a person confirmed with Ebola in Liberia, Sierra Leone, or Guinea. The Los Angeles County Department of Public Health will comply with the State’s order.
10/28/14 - Last week a doctor based in New York, who had treated patients with Ebola in Guinea, tested positive for Ebola. In Los Angeles County there are no confirmed or suspected cases of Ebola, and we remain prepared to respond should a case happen here.
10/21/14 - As the news continues to evolve around Ebola, I want to reassure all residents in Los Angeles County that, to date, there are
no suspected or confirmed cases of Ebola in Los Angeles County. This past week, we have worked diligently to update and strengthen our plans to address Ebola. We are more prepared today than we were yesterday, and we will be more prepared tomorrow than we are today.