The pre-gavel topic at La Jolla civic meetings last week was Hepatitis A, as national headlines about the outbreak in San Diego caused friends and family living elsewhere to reach out and check up. But are La Jollans really as safe as they assured their Facebook friends they are?
So far, in what officials have dubbed the nation's second-largest Hep A outbreak in decades, 16 have died in San Diego, with 421 confirmed or probable cases making the mortality rate just under 4 percent. (Typically, the County reports only two or three hepatitis A cases per month.)
Hep A spreads through infected feces or bodily fluids. The most common ways are sexual contact, needle-sharing or ingestion — either by touching an infected object and then your mouth, or by eating infected food. The virus inflames the liver, and can stop it from working to the point that your body can no longer clear toxins from the blood.
That's not good.
So far, most of the infected have been IV drug-users or homeless people, with cases concentrated in downtown and the cities of El Cajon, Santee and La Mesa. (San Diego has vaccinated about 20,000 people and set up temporary public restrooms and hand-washing stations downtown, where it is also washing the streets with water containing bleach.)
But La Jollans are hardly immune, as they discovered last week when health officials warned that anyone may have been exposed who ate and drank at World Famous Restaurant in Pacific Beach on Aug. 28-30, Sept. 3-4 or Sept. 10-11.
Pacific Beach patient zero was a bartender who handled food, County Public Health officer Wilma Wooten told the Light. The restaurant closed for a couple of days, then reopened.
"The bartender was exposed somewhere else," Wooten said. "They didn't get the infection at the restaurant and there is no reason to stay away from the restaurant. The restaurant did a thorough and full disinfection."
And while La Jolla's homeless population is only a tiny fraction of downtown's, it may trouble readers to learn that all three people interviewed by the Light last week, who live on La Jolla's streets, say they're neither vaccinated nor concerned about the outbreak.
"It's not my problem," said a man, identifying himself as Steven Baumeister, who lives out of a shopping cart next to the CVS Pharmacy driveway at 7525 Eads Ave. "I'm not a dirtbag," the man explained. "Any of those homeless people you're talking about that come in contact with those sorts of diseases obviously participate in (careless) activities ..."
So exactly how freaked-out should La Jollans be right now?
• Doctor's advice
"It's pretty amazing that it's spreading so much," said Dr. Mark Shalauta, a Scripps Memorial-affiliated family medicine specialist and co-chair of the Scripps Health Immunization Committee. "This has been bubbling for many months and everyone kind of thought it'll eventually blow over, but it keeps building."
A worst-case scenario would see Hep A enter the food chain, Shalauta said, as E coli has done in the past. "If someone who works with food or food-packing introduced it that way," he said, "then it would spread like wildfire."
So far, however, that's not the reality. Although the outbreak is worsening, it is not out of control. The City still only recommends vaccinations for homeless people and those around them, for police and other first-responders, and for food-handlers, healthcare workers, janitors, IV drug-users, men who have sex with men, and people with illnesses that damage the liver or immune system.
Shalauta agrees with that prescription — though he has offered vaccinations to the 20 of his patients who have e-mailed so far asking about them.
"It makes a great story, the outbreak and everything like that," Shalauta said, "but we're not seeing it spread through food at this point, so it's not super-concerning. That's the way I'm explaining it to my patients."
Meantime, washing your hands a few extra times a day — and a little more rigorously in public bathrooms — couldn't hurt, Shalauta says.
Oh, and you know those people everyone always makes fun of for only touching the public bathroom door handle with a paper towel?
"All you need is one infected person to wipe without washing and everybody in that bathroom is at risk," Shalauta said.
Q & HEP A
• What is Hepatitus A? An occasionally fatal virus that inflames the liver.
• How can you catch it? By consuming contaminated food or water, by touching fecal molecules left by an infected person and then ingesting them by touching your mouth, or by sexual or other contact with bodily fluids from an infected person.
• What are the symptoms? Not every hepatitis A infection causes them. But they include yellowing of the skin and eyes, fatigue, nausea and vomiting, abdominal pain, clay-colored bowel movements, loss of appetite, low-grade fever, dark urine and joint pain. Symptoms don't usually appear until weeks after exposure.
• Who should get vaccinated? The homeless and those who come into contact with them, food-handlers, healthcare workers, janitors, police and other first-responders, IV drug users, men who have sex with men, and people with illnesses affecting the liver or immune system.
• Who's already immune? Anyone who has ever been vaccinated, which includes most U.S. citizens who have traveled to developing countries (as per the CDC's recommendations). Most California children are also immune, since Hep A vaccinations have been routine since 2006. (They are given in two doses, six months apart — the first providing about 80 percent protection, the second the other 20.) Also immune is anyone previously infected who recovered.
• Do old vaccinations require boosters? No. They're good for life.
• How else can you protect yourself? Wash your hands often, and don't touch doors or other objects in public bathrooms after hand-washing.