King County experiencing a dramatic increase in Hepatitis A cases

Hepatitis virus under magnification

In the past four months, King County has seen a surge in Hepatitis A cases, with 71 confirmed putting the annual average of 5-16 to shame.

It didn’t erupt all of a sudden: with 16 people manifesting the virus’ symptoms since the beginning of the year, the Washington Department of Health had to declare a statewide hepatitis A outbreak on July 30, 2019. Numbers grew exponentially in fall as more people began to show signs of the disease. Then came 2020, with 18 onsets in January, 19 in February and a jump to 28 in March.

Similarly to the coronavirus, hepatitis A thrives in poorly sanitized environments and transmits through contact with infected people and surfaces. It’s a liver infection that originates from the ingestion of the microscopic fecal matter of a bearer. Anyone who has not gotten a vaccine is at risk. It mostly affects the homeless and people who use street drugs, but also inmates, international travelers, people with chronic liver disease, or clotting disorders, and caregivers assisting hepatitis patients. Furthermore, it can transmit through sexual intercourse and the consumption of contaminated foods and drinks. On average, the virus incubates for 28 days, but it can take as long as 50 for its symptoms to manifest, and weeks to months for a person to recover. Hepatitis A has a mortality rate of 0.5%  and does not become chronic, but its symptoms can be debilitating (or completely absent).

Between April 1, 2019, and Jan. 3, 2020, there were 154 cases in the entire state, meaning that, during the same time, symptomatic people in King County alone represented approximately 27% of the affected population, this data is justified by the notoriously high homelessness and drug addiction rates in the county.

However, April also saw a reduction of diagnosed cases, which fell to 17, while only eight people began to show any symptoms. The decrease might be related to COVID-19 precautionary action. The fear of catching this virus could induce possible hepatitis-infectedindividuals to avoid hospitals and clinics, causing their illness to remain unreported and untreated. On a positive note, the drop may be the result of physical distancing, which could have contributed to limit the spread, and of the effectiveness of hepatitis A preventive programs.

In July 2019, King County Executive Dow Constantine announced he was allocating $350,000 from the Loss Control Program fund to extend free hepatitis A vaccinations and limit the spread among the homeless. In 2020, King County added $322,000 to continue the service. These vaccinations are available in various locations and mobile stations. Since January 2019, more than 2,500 homeless and drug users have received immunization.

On April 21, the City of Seattle and Public Health – Seattle & King County announced as a response to both outbreaks, the reopening of restrooms in five public libraries, to ensure better hygienic resources for the unsheltered, in addition to the 160+ active hygiene locations. As reported on the City of Seattle website, Councilmember Dan Strauss said, “We know utilizing the resources we already have is less expensive than renting or buying new hygiene facilities. This is another important step in both addressing the COVID-19 and hepatitis A spike we are experiencing in Ballard. As the city continues to work on additional strategies, we need continued urgent action in Ballard to get people the services they need and better ways to intervene in problematic behavior.”

Strauss referred to the virus hotspot in Ballard, one of the neighbors in North Seattle, where 17 infected homeless individuals were staying. On May 4, the City swept an unsafe encampment in Ballard Commons. Among the reasons were the growth of the encampment and the accumulation of human biowaste (through which hepatitis A spreads the most) despite the stations and the library’s restrooms. Residents received shelter and storage assistance prior to and during the dismantlement.

Public Health is currently investigating how the virus entered one local restaurant associated with five cases, who manifested typical symptoms: jaundice, abdominal pain, nausea, vomiting, fever, and fatigue. These individuals had reportedly visited during Feb. 24-26, but all declared not having connections to homeless people or drug users. However, genetic testing revealed that the virus’ DNA found in two of these cases match the DNA observed in people experiencing homelessness or who use drugs in that area. The restaurant closed on April 17 for disinfection and cleaning. The inspector did not identify infected employees, who later received the vaccination, and instructed them on safety guidelines to prevent spreads from occurring again.

The outbreak is another evidence of King County’s struggle to cope with the homelessness crisis, a phenomenon that is expected to grow as the economy limps towards reopening. With more than 11,000 homeless people, additional funding will be vital to ensure immunization and healthier environments for all.