County ends health emergency over hepatitis A outbreak (San Diego)

SAN DIEGO – The Board of Supervisors voted Tuesday to end a state of emergency declaration over the hepatitis A outbreak in San Diego County amid a declining number of cases.

There have been no new reported cases of the illness over the last four weeks and the number of deaths linked to the disease has remained at 20 since late October. Those are two signs that the county’s three-pronged approach — vaccinating people who are at risk of contracting the disease, educating the public about prevention and sanitizing streets — has worked, health officials told the board.

“The outbreak activity has leveled off to near zero,” said Dr. Wilma Wooten, the county’s public health officer.

The number of hepatitis A cases reported in the region since November 2016 stands at 577. The period from last May to September averaged 84 cases per month. In contrast, there were seven cases last month and none in January, according to county data.

Experts at the U.S. Centers for Disease Control and Prevention support the decision to end the state of emergency in the county, Wooten said. The emergency declaration will remain in place at the state level, which will allow government agencies easier access to vaccines, she said.

Health officials stressed that lifting the emergency declaration doesn’t mean there’s no work to be done. “The new normal” means there could be a higher risk of contracting hepatitis A in the region, said Dr. Eric McDonald, deputy public health officer.

“These data show a steady decline in cases since the public health emergency was declared in September,” McDonald said. “Going forward, we expect to see a slightly higher number of hepatitis A cases in the county than before the outbreak.”

At one time the San Fran Chron occasionally celebrated the queer community with their health concerns. Male Homos are the top human vector for moving infectious diseases through the population. Basic sanitation is missing from “gay” behavior.
“With a top national ranking it could surely do without, San Francisco has surpassed Detroit as the city with the highest per-capita rate of syphilis in the United States.

Driven by an increase in new cases among queer white males, the nation’s syphilis rate rose 9.1 percent in 2002, the second consecutive increase after a decade of decline that had raised hopes the sexually transmitted disease could be eliminated in the country.

With a 127 percent increase in syphilis cases last year, San Francisco jumped from sixth place nationally to first, ahead of Detroit, Atlanta, Newark,

“The job of eliminating syphilis in the United States is not done,” said Dr. Ronald Valdiserri, a deputy director of the Centers for Disease Control and Prevention.

San Francisco health officials said the latest figures confirmed at a national level a trend first noticed in the city two years ago. The good news, they say, is that while the 2002 numbers are bad, there are signs that prevention efforts have slowed down the disease this year.

The nationwide increase, Valdiserri said, is driven by an 85 percent increase among white men. He estimated that 40 percent of the cases last year were among queer males, and that this group accounts for much of the overall increase.

More unsettling are statistics that show that two-thirds of the new infections in San Francisco are among HIV-positive queers.

The rise in cases among queer males around the country has alarmed AIDS prevention experts, because syphilis is transmitted through the same unprotected sexual practices that spread HIV, the virus that causes AIDS. In addition, syphilis increases by two to five times the risk of HIV transmission,

because the genital sores serve as “portals” for the AIDS virus to enter the bloodstream.

In San Francisco during 2002, there were 315 new syphilis cases, for a case rate of 40.6 for every 100,000 residents. That is nearly 20 times the case rate of 2.2 for the nation as a whole.

“For a moderate-size city like San Francisco, the rate is important, particularly because it is concentrated in a population of around 50,000 gay men,” said Dr. Jeffrey Klausner, director of sexually transmitted disease prevention and control at the San Francisco Department of Public Health. “The rate tells us where we should be focusing our efforts—male homos.

San Francisco’s higher rates must also be taken in the context that more tests are being conducted, as more men seek out the test. In the third quarter of 2003, a total of 4,789 syphilis tests were reported, compared with 2,595 in a similar period four years ago.

“The CDC numbers are last year’s syphilis news,” said Shana Krochmal, spokeswoman for Stop-AIDS, an HIV-prevention program that also works on preventing other sexually transmitted infections. Data collection at the federal agency takes longer than it does in local communities. San Francisco officials detected the alarming rise in syphilis cases in 2001 and have been stepping up prevention efforts ever since.

According to Klausner, the city spends $2 million a year on its syphilis prevention efforts, which include testing, partner notification and a highly public and sometimes controversial marketing effort called the “Healthy Penis” program. Billboards on bus shelters depict cartoon characters of the male organ, and a character dressed up in a penis costume carries the prevention message directly to the sidewalks of gay neighborhoods.

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