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Monterey County Declares Hepatitis A Outbreak Among Homeless Population

Health Officials urge preventative measures including vaccination for at-risk populations.

Post Date:02/05/2018 4:46 PM

Since early 2017, the San Diego and Santa Cruz County Health Departments have been investigating local hepatitis A outbreaks among individuals who are homeless or use illicit drugs. Unfortunately, disease levels in Monterey County have now reached outbreak levels.  Since October 2017, hepatitis A has been diagnosed in 9 individuals with a history of homeless in Monterey County.  These individuals did not travel outside of Monterey County so are assumed to have become ill due to transmission within the homeless and illegal drug use communities in Monterey County.

Monterey County Health Department has been working with medical providers, businesses, and homeless service providers to educate individuals about hepatitis A and how to prevent transmission, vaccinate homeless individuals and illicit drug users, and promote disinfection of areas frequented by these populations.  Monterey County’s Health Officer, Dr. Edward Moreno, states, “Despite our efforts, hepatitis A continues to spread among the at-risk population.  To stop the outbreak, we must as a community collectively increase our efforts to end transmission of the hepatitis A virus.”  The Health Department recommends 4 basic strategies:

  1. Vaccination.The Monterey County Health Department recommends that all providers serving the homeless, injection drug users, incarcerated individuals, international travelers, and men who have sex with men actively seek opportunities to vaccinate their patients in these high-risk groups.  Individuals who work closely with homeless people and illicit drug users on a frequent and ongoing basis, such as those who work or volunteer at homeless service agencies and syringe exchange programs, as well as health care workers who provide ongoing direct medical care to these populations, should also consider vaccination against hepatitis A at this time.
  2. Education.Health care providers, businesses, and community service providers should inform their at-risk clients and patients about the spread of hepatitis A in Monterey County and how they can protect themselves.Easy-to-read handouts in English and Spanish about hepatitis A are available for download at
  3. Increased Hand Hygiene.Everyone can play a role in addressing this public health issue by stressing the importance of hand-washing with soap and warm water after using the bathroom and before preparing, serving, or eating food. Hand sanitizers do not replace the need for hand washing.
  4. Disinfection.Businesses with public restrooms should increase the frequency of cleaning AND disinfecting bathroom surfaces. For heavily used restrooms, clean and then disinfect multiple times per day. Use a chlorine-based disinfectant (bleach) with a ratio of 1 and 2/3 cup of bleach to one gallon of water. Remind employees of the importance of wearing disposable gloves and hand-washing with soap and warm water after cleaning restrooms. Additional guidance is available on the Health Department’s website at

Hepatitis A is a disease of the liver caused by the hepatitis A virus.  Symptoms of hepatitis A infection include fever, tiredness, nausea, vomiting, loss of appetite, stomach pain, yellowing of the skin or eyes (jaundice), dark urine, pale stools, and diarrhea.  Some people may not feel sick but can still pass the disease to others.  A person can get hepatitis A though eating or drinking food contaminated with hepatitis A or by touching objects contaminated with hepatitis A and then touching the mouth or food.  Hepatitis A can also be transmitted during sexual contact with an infected person.  Contamination happens when an infected person does not wash his or her hands properly after going to the bathroom.

For more information about hepatitis A, visit the Monterey County Health Department’s hepatitis A website at or the California Department of Public Health’s hepatitis A outbreak website:

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