Case of Hep A in King County concerns public health officials

A homeless man in King County has been hospitalized with a case of hepatitis A, a highly contagious virus that infects the liver.

The case has caused concern among public health officials who worry about a potential outbreak in the area.

There have been a number of hepatitis A outbreaks around the country in people who are homeless or using drugs in recent years.

San Diego saw nearly 600 cases and 20 deaths —many of which were people who were homeless — during a large outbreak that began at the end of 2016.

The man diagnosed recently in King County appears to have contracted the disease locally, according to Dr. Jeff Duchin, health officer for Public Health – Seattle & King County.

Duchin said that’s worrying.

“It suggests to us that there may be unrecognized transmission of this disease happening in the community,” he said.

Duchin said this could be a sentinel case, indicating something bigger is possible.

"We do believe we have a very large vulnerable population that would be susceptible to hepatitis A transmission and a potentially large and complicated outbreak," he said.

Duchin said it’s important to get as many people as possible vaccinated.

People who are homeless, people who use illicit drugs, men who have sex with men, and international travelers are among those who are at high-risk for contracting the virus. People with underlying health issues, including many people who are homeless, are at higher risk of severe illness if they contract hepatitis A.

Since becoming aware of outbreaks in other parts of the country, public health officials have been working with primary care providers, service providers, and emergency rooms to promote vaccinations for people who are at a high risk for hepatitis A, Duchin said.

Following the recent diagnosis, they've ramped up efforts to provide vaccinations at shelters, other service sites, and unauthorized camps, including places the patient may have visited.

Duchin said the number of hepatitis A vaccinations that have been administered so far is in the hundreds.

“We’re going to be doing as many community-based vaccination clinics as we can to offer vaccines to people who are experiencing homelessness,” Duchin said.

They’ve also been stressing the importance of access to good sanitation services in order to prevent transmission within the population.

The virus is usually spread when someone unknowingly ingests it from objects, food or drink that are contaminated. Contamination occurs if an infected person doesn’t wash their hands well after using the toilet and transfers small amounts of the virus to other objects or surfaces.

Hepatitis A can also spread through close contact with an infected person, including through sex.

Duchin said public health will be tracking the situation closely and may not see other cases.

“But we also recognize that we’re sitting on a tinderbox and I’m very concerned that sooner or later we’ll be very vulnerable if we don’t get many of our vulnerable people immunized in advance,” he said.

On any given night, there are more than 12,000 people experiencing homelessness in King County.

There were 14 cases of hepatitis A reporter in King County last year and eight cases have been reported so far this year. None of the previous cases that were contracted locally were in people experiencing homelessness, according to Duchin.