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Two years later, the hepatitis A epidemic in San Diego is finally over.
Dr. Wilma Wooten, County Public Health Officer, said Monday that the time has now passed to formally declare a curtain call for the contagion that killed 20 people, sickened nearly 600 and prompted a complete rethink. how the region manages homelessness.
"Last Thursday, there were officially 100 days since the last case to date and, for hepatitis A, it is the threshold we use that allows us to say that it no longer corresponds to the definition of an outbreak, "Wooten said.
Detected by the Ministry of Health at the end of February 2017, infectious disease detectives followed the first probable case until the week of November 22, 2016. In the late spring of last year, there had been hundreds of cases, a dozen deaths and a growing public outcry. something had to be done about unhealthy living conditions among the homeless population in the region.
Under pressure from many people who work daily with the homeless, the city and county government met in September to promote vaccination and sanitation, launch street cleaning campaigns, install portable toilets and hand-washing stations, then temporary shelters large enough to accommodate 700 people at a time.
According to Bob McElroy, director of Alpha Project, with an estimated cost of more than $ 12 million, the fight against the epidemic was not expensive, but that's what it took to cover years of deferred interview for the homelessness problem.
Today, Alpha Project is one of the many organizations that operate new accommodation centers and McElroy says he is convinced that hepatitis A is the sad proof that homelessness does not exist. can not be ignored forever.
"In reality, if you have a place where people can be safe and have access to health care, you simply will not meet the type of sanitation problems you encounter with the tent cities installed in the cities. streets, "said McElroy.
Although the San Diego epidemic was significantly reduced at the beginning of the year (there were only 15 new cases in 2018), other communities in the country are still fighting.
An epidemic map maintained by the US Centers for Disease Control and Prevention is linked to the latest information on the epidemic in a dozen states, with the latest Kentucky message showing 2,275 cases and 14 deaths; West Virginia had 1,671 cases by October 26 and Michigan, whose epidemic began in August 2016, now has 898 cases and 28 deaths.
Nationally, the combined total number of cases now exceeds 8,000, with 76 deaths and more than 4,500 hospitalizations. On Thursday, the CDC is expected to publish a comprehensive report on all outbreaks in 2017, which should shed further light on the situation.
Although far from being the only country in the country to fight hepatitis A and fecal contamination of homeless people and drug addicts, the San Diego epidemic quickly drew the attention of the population to following the announcement of death and the growing number of cases per week.
Although the epidemic in Michigan has been going on for longer, the outbreak of cases in San Diego has become an immediate national news.
Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, has hypothesized that national attention easily attaches to the contrast of 39, a wealthy city besieged.
"You think of San Diego as a vacation destination and now, suddenly, you hear about hepatitis and unhealthy conditions," Osterholm said. "This contrast will attract more media attention, much like a measles outbreak in Disneyland will draw more attention than that of a school in a metropolitan area, even though the number of cases is the even".
He praised San Diego's willingness to spend the money needed to control the outbreak, as well as Dr. Jonathan Fielding, a distinguished professor at the UCLA Fielding School of Public Health.
"Hepatitis A is very contagious," Fielding said. Getting something like that, it takes money, an enlightened bureaucracy and a lot of coordination. It's clear that you have it in San Diego.
Now comes the really difficult part: Supporting what took so much work to build.
"What this shows is that it's not something you can just assume that you're going to be dealing only with vaccination. You have to look at the sanitary conditions, the housing possibilities, and listen to the people who really live in that environment, "said Fielding. "I hope San Diego's elected officials and many places will not forget it. The need for resources and cleanliness does not end simply because the hepatitis A outbreak is over. "
Osterholm agreed, adding that outbreaks of infectious diseases, in these moving and still mobile days, are still at the rendezvous.
"You can expect to see continued migrations of destitute populations to the San Diego area from other places where, as we know, epidemics are continuing. So it's hard to say that everything is really over forever, "said Osterholm.
It is clear that new practices are in place and will continue even after the official end of the epidemic.
For example, the county began using mobile vaccination "foot teams" to send public health nurses accompanied by law enforcement officers to homeless camps during the outbreak. Although not as widespread as they once were, Wooten said football teams are now a standard tool in its toolkit, ready to be used on a case-by-case basis.
And the county, which administered more than 200,000 doses of vaccine during the outbreak, learned a thing or two about how to do this work in collaboration with public health clinics and others.
According to Mr. Wooten, one of the key lessons learned is that it often took months to convince the most at-risk homeless residents to roll up their sleeves.
"When we started going out in late April and in May, people said that they thought it was a government plot," Wooten said. "But we knew it would take time for this population to trust us and we just had to go back and commit ourselves to build that trust."
The San Diego Public Health Service also insisted that homelessness be considered a valid indication for routine hepatitis A immunization.
Last week, the CDC's Advisory Committee on Immunization Practices formally added homeless people to the official list of why physicians should urge their patients to be vaccinated.
Data from the San Diego outbreak was used as a kind of case study by the immunization expert group that made the decision.
Dr. Eric McDonald, Medical Director of the Department of Epidemiology and Immunization Services of the County Health Department, said it was satisfying to see the experiences in San Diego help change the national policy.
"It's really good that we can use this experience to help others, and it's interesting to bring it to the national level," said McDonald.
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Twitter: @paulsisson
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