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SALT LAKE CITY — Health officials say Salt Lake County's homeless are encountering an "outbreak" of hepatitis A, and that the disease is believed to be related to the strain that has killed 17 people in San Diego this year.
In all, 25 "outbreak-related" cases of hepatitis A have been reported in the county since the start of 2017, said Irene Risk, director of epidemiology for the Salt Lake County Health Department. There were six cases reported in the first 16 days of this month alone.
Officials are "not sure if the outbreak has peaked yet," and reported that none of those cases have turned fatal.
"What I'm hoping is that we don't see that peak go up. It takes on average 30 days to develop symptoms after you're exposed. It's hard to tell where we're at," Risk said.
More than half of the cases have led to hospitalizations, Utah Department of Health spokeswoman Jenny Johnson said.
Typically, there are about four cases of hepatitis A in Salt Lake County per year, according to Risk.
Those who are suffering from hepatitis A are overwhelmingly homeless, said Salt Lake County Health Department spokesman Nicholas Rupp, in large part because "for those experiencing homelessness, there are not always opportunities to cleanse properly (or even find) an appropriate place to use the restroom."
Risk told KSL "there's no reason to think that the general population is at risk."
Rupp added that illicit drug users have also been disproportionately affected in Salt Lake County's outbreak.
Hepatitis A can be spread through the feces of an infected person in even miniscule amounts, meaning a person who touches a contaminated object and later touches their mouth with their hands, or eats contaminated food or drink, can be at risk. Not washing hands after using the restroom is considered a behavior that increases risk of infection.
"Wash your hands before you eat (and) after you use your restroom," pleaded Laurel Ingham, development director at the 4th Street Clinic. "Wash (long enough to) sing your ABCs, wash with soap and water. Make sure you really get enough that it's going to cover your hands and do it completely."
Hepatitis A can also be spread through sexual contact, according to the Centers for Disease Control and Prevention. The disease harms the liver, leading to symptoms such as fatigue, joint pain, jaundice, stomach pain, fever and nausea for anywhere from several weeks to six months, the federal agency says. Hepatitis A's effects are wide ranging, with many of its victims never exhibiting symptoms while others, in severe cases, suffer liver failure and death.
More than 450 hepatitis A cases have been reported since November in a San Diego area outbreak largely affecting homeless people, including 17 fatalities. Salt Lake County health officials first confirmed in early July that the local cases "are the same strain" affecting people in San Diego, Risk said.
"We looked at the pathogen and looked at whether it was the exact phenotype and the same strain and we found out that it was," she said.
Risk was quick to add that "I don't think that we will reach those levels" of cases as seen in San Diego. But "as far as the scope (in Salt Lake County), it's very concerning and we're taking a lot of actions."
Those actions consist primarily of widespread vaccinations, Rupp said — 780 so far.
Rupp spoke positively of Operation Rio Grande, the crackdown aimed removing crime and drug use from downtown, saying it would improve overall health "long term" among those who are homeless. But he said the effort also dispersed many of the people believed to be at risk of hepatitis A, adding a hurdle to vaccination efforts.
"They've spread further throughout the (Salt Lake) Valley, so it's more complicated and more time consuming to reach more people, because we have to reach more places," he said. "It's been a little more challenging with them dispersed throughout the community, rather than within more or less a few blocks."
Risk said workers have been going to anywhere where they know they can find homeless people and drug users, including drug rehabilitation clinics, parks and outdoor events, taking the vaccinations with them and often administering them on the spot.
"We always are looking for those kinds of opportunities," she said.
Matt Minkevitch, executive director of the Road Home, praised the Salt Lake County Health Department for their providing of vaccinations, saying "we're in good hands."
He said the department has set up tables at the Road Home where people can approach health workers to get inoculated — and that workers are also scouring the area outside the shelter, recruiting those who not yet received the vaccination.
"I would want these people caring for me, because they are on a mission. They have a sense of purpose, a cause," Minkevitch said.
Vaccinations for hepatitis A are also available at 4th Street Clinic, Ingham told KSL.
The shelter, Minkevitch said, is "doing our utmost to put the word out" about not only the availability of vaccinations, but the importance of preventing hepatitis A infection with thorough hand washing.
"We're doing everything we can to be supportive," Minkevitch said.