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A fifth person has died as a result of the hepatitis A outbreak in San Diego County that now totals 228 cases, the County Health and Human Services Agency announced today.

During the local outbreak, 161 people have been hospitalized.  People who are either homeless or using illicit drugs account for at least seven in ten of the illnesses, and just over one in five also have hepatitis C.

Hepatitis A is most commonly spread person-to-person through the fecal-oral route. Public health investigators are continuing to evaluate cases, but so far no common food, drink or drug source has been identified as a contributing cause to this outbreak.

“It is imperative that anyone at risk for hepatitis A get vaccinated,” said Wilma Wooten, M.D., M.P.H., County public health officer. “We cannot stress this enough – get vaccinated and make sure you wash your hands after going to the bathroom.

“Lives are at risk. Protect yourself, your family and the community.”

The County has been working with community partners to conduct vaccination clinics for people who are at risk for hepatitis A.  These partners include homeless services providers, community health clinics, faith-based community organizations, substance use treatment providers, hospital emergency departments, jails, and probation facilities.

Symptoms of hepatitis A include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools.  Symptoms usually appear over a number of days and last less than two months.  However, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and even death.

The best way to prevent hepatitis A is by getting vaccinated. The hepatitis A vaccine became available in 1995 and is recommended as part of the routine childhood vaccination schedule. However, many adults have not been vaccinated and may be susceptible to the hepatitis A virus.

In addition to children, hepatitis A vaccine is routinely recommended for the following high-risk groups:

  • Travelers to countries that have higher rates of hepatitis A (check the CDC Travelers’ Health website for places where vaccination is recommended)
  • Users of injection and non-injection illegal drugs
  • Homeless people
  • Men who have sex with men
  • People with chronic liver diseases, such as cirrhosis, hepatitis B or hepatitis C
  • Household or sexual contacts of hepatitis A patients

Because of the local outbreak, unvaccinated individuals who work closely with the homeless and with illicit drug users are recommended to get the hepatitis A vaccine. People who should get the vaccine include:

  • People who work or volunteer at homeless services agencies
  • Health care or public safety personnel who work on a frequent and ongoing basis with the homeless or illicit drug users
  • People involved in sanitation or clean up in areas where the homeless are located.

Anyone in San Diego County who is concerned about getting hepatitis A is encouraged to get the vaccine if they have not already gotten it.

Hepatitis A vaccine is available at many doctors’ offices and clinics and at some retail pharmacies.  For persons without health insurance, vaccine is available at County Public Health Centers.  For a list of locations, call 2-1-1 or visit

Hepatitis A can also be prevented through good hygiene.  Everyone should:

  • Wash their hands for 20 seconds (about the length of time to sing “Happy Birthday” twice) with soap and running water before eating and after using the restroom or changing a diaper
  • Do not directly touch the door handle when exiting a public restroom
  • Do not share food, drinks, or smoking materials with other people

For general information on hepatitis A, visit the HHSA hepatitis website where data are updated routinely. A hepatitis A fact sheet is also available.


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