Nationwide shortage of hepatitis A vaccine is bad news for San Diego and surrounding counties

Pediatric and combination hepatitis A/B vaccines remain plentiful

Live Well San Diego
This chart details the number of reported hepatitis A cases in San Diego from November 2016 to November 2017.

■ By Kyle Selby / Reporter

A couple of weeks ago, Riverside County health officials revealed that a man from Riverside was diagnosed with the same strain of hepatitis A linked to a deadly outbreak in San Diego that has claimed the lives of 20 infected people as of Nov. 20. It has been called “one of the largest person-to-person hepatitis A outbreaks in the country,” and it is spreading not only within San Diego, but surrounding counties as well.
Due to this outbreak and others like it around the country, the U.S. Centers for Disease Control and Prevention (CDC) is saying that there may not be enough of the hepatitis A vaccine to go around nationwide.
In a written statement to CNN, the CDC stated that “current supply is not sufficient to support demand for vaccine.”
The virus has also largely broken out in Southeast Michigan last year, mostly in Macomb and Wayne counties, and also Detroit. At least 495 people in these areas have been diagnosed, and at least 19 have died. At least 536 people have tested positive for the virus in San Diego, and the numbers are still climbing.
The hepatitis A virus (HAV) is a highly contagious liver disease transmitted most frequently when the fecal matter of an infected individual is consumed orally. This includes eating food or drinking liquids prepared by somebody who has not thoroughly washed their hands, but can also be transmitted through sex and illicit drug use. Poor hygiene and access to ill-managed bathroom facilities are a large contributor to the spread of the virus, therefore it is found commonly among homeless populations.
One individual in the Riverside mid-county area near Hemet tested positive this year, but the case was not related to the outbreak in San Diego, and the person has since been treated. Both Los Angeles and Santa Cruz counties have also experienced an uptick in hepatitis A cases. In the last four years the largest number of positive hepatitis A cases in a year in Riverside County was 14.
Symptoms of the virus generally take 15 to 20 days to surface, which include vomiting, fever, fatigue, loss of appetite and jaundice, which yellows the skin or eyes. Affected individuals are most contagious during the two weeks before jaundice becomes visibly noticeable.
According to the CDC, staff has been working closely with public health officials so that the populations most at-risk will be targeted for vaccination.
“Monitoring and managing public and private vaccine orders to make the best use of supplies,” is their priority, said the CDC. The only two companies authorized by the Food and Drug Administration to sell the vaccine in the U.S. are GlaxoSmithKline and Merck.
“It’s unprecedented what we are seeing out of California and other parts of the country,” said Robin Gaitens, spokesperson for GlaxoSmithKline. “The shortage is simply an issue of supply and demand.”
Gaitens said that GlaxoSmithKline typically gives 1.2 million adult doses in the U.S. each year, but the demand this year has surpassed that. However, the pediatric version and the combination hepatitis A/B vaccine are widely available. Gaitens disclosed that her company has been working closely with the CDC and California officials to “distribute and to ensure the vaccines are actually going to where there is the greatest need.” Merck provided a similar statement.
The first HAV vaccine was approved in Europe in 1991 and the United States in 1995. The vaccine has been proven to be more than 95 percent effective after the first dose, and nearly 100 percent effective after the second, which is recommended. Individuals who recover from the disease become immune to the disease onward.
San Diego is actively working to eliminate (or at the very least, contain) the outbreak, by power-washing the streets, cleaning up trash in homeless hotspots, and vaccinating about 100,000 people so far.
The best way to avoid being exposed to the virus is to practice good hygiene. Riverside County Public Health advises that people wash their hands thoroughly after using the restroom, and getting the hepatitis A vaccine, if available.
If you suspect that you or a loved one may be infected with the potentially lethal virus, please contact your healthcare provider right away, and set up an appointment for checkup.

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