EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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ISSUE FOCUS: MANAGEMENT & OPERATIONS 28 SEPTEMBER 2018 | EMSWORLD.com R ecently there have been several outbreaks of hepatitis A viral (HAV) infection among homeless populations. Most coverage has focused on a group in the San Diego area; however, there have also been outbreaks in other cities in California, including Santa Cruz and Los Angeles. As of November 2017 there had been a total of 644 cases report- ed, with 360 hospitalized and 21 deaths (20 in San Diego, another in Santa Cruz). The outbreak in California is the largest person-to-person hepatitis A outbreak not related to contaminated food or a single source, and cases have also been noted among drug users. The California outbreak, unlike others, has resulted in deaths. Death associated with hepatitis A infection is rare; the disease has tradition- ally been described as self-limiting and not resulting in chronic infection. Gener- ally HAV infection runs its course with no long-term effects. Those who have had HAV acquire immunity and cannot get it again. Beyond California, other states have had HAV outbreaks among the same pop- ulation groups, including Utah, Michigan, and Colorado. One common element is their occurrence in the homeless popula- tion at a rate higher even than that of IV drug users in the same area. What can be done to bring such out- breaks under control? Hepatitis A Viral Infection The hepatitis A virus (HAV) is transmitted by the fecal-oral route. The virus is excreted in the stool of an infected person and then ingested by mouth following contact with unwashed hands or contaminated objects. With no bathroom or hand-washing facili- By Katherine West, RN, BSN, MSEd HEPATITIS A IN THE HOMELESS California battles an outbreak among the homeless and drug users

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