The URL can be used to link to this page

Home My WebLink About2023-03-21; City Council; ; Hepatitis A - 2017 Outbreak and Current SituationCA Review ___AF___ Meeting Date: March 21, 2023 To: Mayor and City Council From: Scott Chadwick, City Manager Staff Contact: Kim Young, Assistant Director of Emergency Services kim.young@carlsbadca.gov, 760-457-1142 Subject: Hepatitis A - 2017 Outbreak and Current Situation Districts: All Recommended Action Receive a report on the 2017 Hepatitis A outbreak in San Diego County and an update on recent reports from the County of San Diego regarding a slight increase in Hepatitis A cases identified among people experiencing homelessness. Executive Summary The City of Carlsbad received a letter from the San Diego County Public Health Officer on March 2, 2023, reporting that there’s been a slight increase in Hepatitis A cases among people experiencing homelessness. (Exhibit 1) The current cases do not constitute an outbreak such as the one that occurred in 2017 and 2018, but jurisdictions in San Diego County are being encouraged to take preventative actions to prevent an increase in Hepatitis A cases. This report summarizes the 2017 hepatitis A outbreak in San Diego County, the current Hepatitis A situation in San Diego County and the City of Carlsbad’s current state of readiness. Explanation & Analysis About hepatitis A Hepatitis A is a highly contagious viral infection that can affect the liver. Individuals most at-risk for infection include people experiencing homelessness, illicit drug users, staff that work in homeless services and substance use treatment settings, public safety and emergency workers, healthcare workers and sanitation workers. The virus is transmitted through close, personal contact when human waste (even trace amounts) from an infected person is ingested by another person. Hepatitis A symptoms are similar to the flu and may include yellow skin or eyes, upset stomach, fever, and joint pain. The symptoms typically appear two to seven weeks after infection and can last anywhere from a few weeks to a few months. Not everyone infected with hepatitis A has symptoms, and most people recover without suffering lasting liver damage. According to public March 21, 2023 Item #8 Page 1 of 6 health officials and the Centers for Disease Control and Prevention, the best way to prevent a Hepatitis A infection is to get vaccinated and practice good hygiene.1 The 2017 hepatitis outbreak A hepatitis A outbreak in San Diego County was initially identified in March 2017, and the County of San Diego declared a local health emergency in September 2017. Accordingly, the City of Carlsbad implemented a comprehensive response operation in coordination with public, private and non-profit partners. There were 592 confirmed cases and 20 deaths in the county during the 2017 outbreak, according to data from the San Diego County Department of Public Health website. The majority of cases were among people experiencing homelessness and/or illicit drug users. Notably, most of the cases were reported in the City of San Diego; only four cases were reported in the City of Carlsbad. The 2017 outbreak prompted a region-wide emergency response between the California Department of Public Health, the San Diego County Department of Public Health, the City of Carlsbad and other jurisdictions in the region. The San Diego County Department of Public Health’s emergency response focused on three operational activities: • Vaccination • Sanitation • Education The most effective strategy for slowing the outbreak was to target the at-risk populations for vaccination as a first step. County health nurses held over 2,500 vaccination events between March 2017 and October 2018, and mobile foot teams of nurses, homeless outreach workers and law enforcement officers were deployed to conduct vaccinations in locations where homeless populations congregate, such as canyons and service provider locations. The response then turned to region-wide sanitation efforts that included expanding access to public restrooms, installing handwashing stations and street cleaning and sanitation projects. Finally, the County implemented a hepatitis A public outreach campaign to inform the public about vaccination locations, proper handwashing techniques, disinfection protocols and how to report areas requested for sanitation. Vaccination, sanitation and education each proved to be an important strategy in halting the spread of the outbreak. The City of Carlsbad and the San Diego County Department of Public Health worked closely together during the outbreak to coordinate emergency response activities. Following the public health emergency declaration, the Carlsbad City Council passed the Hepatitis A Ordinance in November 2017. This ordinance allowed after-hours access to portable restrooms and hand- washing stations. The ordinance also deployed additional law enforcement officers at city parks with portable restrooms. 1 For more information, see Hepatitis A Questions and Answers for the Public at cdc.gov/hepatitis/hav/afaq.htm March 21, 2023 Item #8 Page 2 of 6 The city’s response activities aligned with the county’s operational response, focusing on vaccination, sanitation and education. County health nurses administered vaccinations to at-risk populations throughout Carlsbad, and vaccinations were offered to City employees at no cost. The City of Carlsbad increased sanitation activities in public areas and expanded access to public restrooms by deploying additional portable restrooms and handwashing stations in city parks, the Village area and areas where homeless populations congregate. The City of Carlsbad also created a public outreach campaign to provide education to city employees and community members on vaccination locations, and proper handwashing techniques, along with updates from San Diego County public health officials. To organize the City’s emergency response, the City of Carlsbad used the standard emergency management practice of the Incident Command System. Personnel from the Carlsbad Fire Department served as the incident commanders and led a cross-functional, multi-department team to ensure a coordinated emergency response. With the City of Carlsbad’s and the county’s comprehensive response efforts, and with similar and supporting activities by regional partners, the County of San Diego ended the regional Hepatitis A public health emergency in January 2018. Hepatitis A in 2023 According to a California Health Alert Network advisory issued Feb. 10, 2023, six acute hepatitis A infections have been confirmed among San Diego County residents, with the onset of symptoms beginning Jan. 10, 2023, through Feb. 6, 2023. The cases are concentrated in the City of San Diego, and three of the those infected are people experiencing homelessness. The County of San Diego has not declared a public health emergency, and the current cases do not constitute an outbreak. However, jurisdictions in San Diego County are being encouraged to take preventative actions to prevent an increase in hepatitis A cases. The following activities are recommended by the San Diego County Public Health Officer to minimize communicable disease transmission and reduce the chance for outbreaks: • Work to provide housing and/or provide frequent cleaning, along with handwashing stations and portable restrooms in local encampment areas • Enhance all public sanitation and hygienic procedures where unsheltered persons are present • Provide outreach and education to employees, residents businesses, and other impacted agencies Carlsbad is ready to leverage previous experience and current capabilities should a Hepatitis A outbreak occur. Senior officials across relevant city departments have been informed of the current situation and are already working together to ensure the city is prepared. For example, city staff have assessed and confirmed existing public restroom resources throughout the city, which entails 13 portable restroom locations and 26 permanent restroom locations; each of those locations has associated hand washing stations, either permanent or temporary. Furthermore, city staff have identified additional locations where portable restrooms and handwashing stations can be deployed in case of a declared public health emergency. March 21, 2023 Item #8 Page 3 of 6 Next Steps City staff will continue to continuously monitor the situation and collaborate with San Diego County Public Health to receive updates on Hepatitis A cases. Staff will report back to the City Council as the situation warrants. Environmental Evaluation This action does not constitute a project within the meaning of the California Environmental Quality Act under California Public Resources Code Section 21065 in that it has no potential to cause either a direct physical change or a reasonably foreseeable indirect physical change in the environment. Exhibits 1. March 2, 2023, letter to cities from San Diego County Public Health Officer Dr. Wilma Wooten March 21, 2023 Item #8 Page 4 of 6 March 2, 2023 TO: All City Managers FROM: Wilma J. Wooten, M.D., M.P.H., Public Health Officer, Public Health Services Re: ACTIONS NEEDED TO PREVENT AN INCREASE IN HEPATITIS A CASES As public health officer, I am sending you this communication on behalf of the Public Health Services (PHS) department (local health department), in the County of San Diego Health and Human Services Agency. It has been over three months since my last communication with you regarding sanitation issues. We greatly appreciate your feedback and input on the 2022 Cities’ Sanitation Survey, administered on November 23, 2022, and look forward to reviewing and providing results of this survey during the coming months. As you may be aware, the local health department is working to prevent a further increase in cases of hepatitis A in San Diego County. While the current cases do not constitute an outbreak (defined as three or more epidemiologically linked cases in a certain time period), a proactive approach will help prevent the further spread of disease. As you may recall, the 2017 hepatitis A outbreak was spread by person-to-person exposure and through contact with surfaces contaminated with fecal matter—disproportionately impacting those who were unsheltered. During and since this incident, PHS has implemented robust hepatitis A vaccination strategies to inoculate the unsheltered. In addition, as city partners, we have worked together on education and outreach efforts to prevent hepatitis A. However, the hepatitis A virus is resilient and additional actions are needed when an increase in cases is observed, as we are seeing now. Enhanced sanitation and education will minimize transmission of communicable diseases and reduce the chance for outbreaks. Jurisdictions with increased concentrations of unsheltered persons should take the following preventive measures to reduce the risk of an outbreak, where applicable: •Locate any encampment locations in your jurisdiction and work to provide housing and/orprovide frequent cleaning, along with handwashing stations and portable restrooms. •Enhance all public sanitation and hygienic procedures where unsheltered persons arepresent. •Provide outreach and education via the distribution of the hepatitis A Fact Sheet,sanitation information, and other resources to your employees, residents, businesses, andother impacted agencies. For available hygiene kits, please contact the County of SanDiego Office of Homeless Solutions at HSEC-OHS.HHSA@sdcounty.ca.gov. NICK MACCHIONE, FACHE AGENCY DIRECTOR HEALTH AND HUMAN SERVICES AGENCY PUBLIC HEALTH SERVICES WILMA J. WOOTEN, M.D., M.P.H. PUBLIC HEALTH OFFICER Exhibit 1 March 21, 2023 Item #8 Page 5 of 6 Hepatitis A Letter to Cities March 2, 2023 Page 2 of 2 For additional information about hepatitis A and associated resources, please go to the County of San Diego hepatitis A webpage, where you will find data about the virus, sanitation resources, press releases, FAQs, and other resources. Your decisive leadership, action, and support are essential to protect the public and prevent the spread of this virus. If your employees or residents have questions or concerns related to hepatitis A, please encourage them to call 2-1-1 for general information. For questions, please contact Dr. Ankita Kadakia, Deputy Public Health Officer, at ankita.kadakia@sdcounty.ca.gov. Thank you for your continued partnership and support to keep the residents of San Diego County healthy, safe, and thriving. Sincerely, WILMA J. WOOTEN, M.D., M.P.H. Public Health Officer cc: Helen Robbins-Meyer, County of San Diego, Chief Administrative Officer Nick Macchione, FACHE, County of San Diego, Director, Health and Human Services Agency Sarah Aghassi, County of San Diego, Deputy Chief Administrative Officer, Land Use and Environment Group March 21, 2023 Item #8 Page 6 of 6 Hepatitis A Report 2017 Outbreak and Current Situation Kim Young, Assistant Director of Emergency Services March 21, 2023 1 ( City of Carlsbad TODAY’S PRESENTATION •Hepatitis A background •2017 Hepatitis A outbreak •Hepatitis A current situation ITEM 8: HEPATITIS A REPORT 2 { City of Carlsbad RECOMMENDED ACTION Receive a report on the 2017 Hepatitis A Outbreak in San Diego County and an update on recent reports from the County of San Diego regarding slight increases in Hepatitis A cases identified among people experiencing homelessness. ITEM 8: HEPATITIS A REPORT 3 { City of Carlsbad BACKGROUND: HEPATITIS A •Highly contagious viral infection that can affect the liver •At-risk individuals include persons experiencing homelessness and illicit drug users •Transmitted through close, personal contact •Flu-like symptoms such as fever ITEM 8: HEPATITIS A REPORT 4 { City of Carlsbad 2017 OUTBREAK County of San Diego declared a local public health emergency in September 2017 Majority of cases were among persons experiencing homelessness and/or illicit drug users ITEM 8: HEPATITIS A REPORT 5 529 CASES 20 DEATHS ( City of Carlsbad HEPATITIS A: 2017 OUTBREAK •Regionwide emergency response between the County of San Diego, City of Carlsbad and other jurisdictions •Three operational response activities Vaccination Sanitation Education ITEM 8: HEPATITIS A REPORT 6 • • • --- 2023 CURRENT SITUATION •San Diego County Public Health notified regional jurisdictions of a slight increase in Hepatitis A cases (March 2023) •Current cases do not constitute an outbreak •All current cases are in the City of San Diego and primarily among people experiencing homelessness ITEM 8: HEPATITIS A REPORT 7 { City of Carlsbad 2023 CURRENT SITUATION •County of San Diego has not declared a public health emergency •County of San Diego Public Health Officer recommends the following activities Sanitation:portable restrooms and handwashing stations Education:community outreach ITEM 8: HEPATITIS A REPORT 8 NEXT STEPS •The City is ready to leverage previous experience and current capabilities •Senior officials are informed and working together •Existing public restroom and handwashing resources have been assessed and confirmed •Hepatitis A vaccines administered at La Posada •City staff is monitoring the situation and collaborating with San Diego County ITEM 8: HEPATITIS A REPORT 9 { City of Carlsbad HEPATITIS A PREVENTION •County of San Diego recommends the following to stay healthy –Practice good hand hygiene by thoroughly washing hands with soap and warm water –Get the Hepatitis A vaccine if you are among those at increased risk of infection ITEM 8: HEPATITIS A REPORT 10 { City of Carlsbad RECOMMENDED ACTION Receive a report on the 2017 Hepatitis A Outbreak in San Diego County and an update on recent reports from the County of San Diego regarding slight increases in Hepatitis A cases identified among people experiencing homelessness. ITEM 8: HEPATITIS A REPORT 11 { City of Carlsbad