RESPONSE TO HEPATITIS A & HOMELESSNESS Graham Mitchell - - PowerPoint PPT Presentation

RESPONSE TO HEPATITIS A & HOMELESSNESS

Graham Mitchell Assistant City Manager City of El Cajon

EL CAJON’S RESPONSE TO HEPATITIS A

 Collaboration with San Diego County  Strategic Approaches  Communication  Perspective

STRATEGIC APPROACHES

 Vaccinate “High Risk” Individuals

• Homeless/Drug Users
• Food Handlers
• Service Providers

STRATEGIC APPROACHES

 Valued Partnerships

• County of San Diego
• Community Groups
• Business Partners

 Information Campaign

• Target Businesses
• Website/Social Media
• Rec Centers/Library

HOMELESS ASSISTANCE EFFORTS

HOMELESS ASSISTANCE EFFORTS

1) Housing Navigator 2) Housing Assistance Funds (flexible) 3) “Real CHANGE, not spare change” 4) Animal Shelter 5) Homeless Services Phone App

HOMELESS ASSISTANCE EFFORTS

6) Reunification Program 7) Homeless Outreach Team 8) SDSU Public Administration 9) Regional Leader 10) Motel Conversion Program

Questions/Comments

City of Chula Vista

Hepatitis A Outbreak – Public Health & Safety Response

Hepatitis A in Chula Vista

• 17 confirmed cases in Chula Vista
• In coordination with County of San Diego Public Heath, delivered:
• 550 hygiene kits
• 35 vaccination events
• 2,739 vaccinations

Response Strategy

Vaccinate

• Vaccinate those most at‐

risk

• Vaccinate employees with

exposure to at‐risk populations Sanitize

• Implement recommended

sanitation guidelines

• Encourage all employees

to practice proper and frequent sanitation Educate

• Promote awareness and

provide education materials to employees

• Provide local businesses

with education materials

• Post handwashing

information in all City facilities

Chula Vista Response Vaccinate

• CVPD Homeless Outreach Team (H.O.T) working with

County of San Diego Public Health Nurses since June 2017

• Eight vaccination operations conducted between June‐

October

• Visited all areas where at‐risk populations are known to

congregate

• Approximately 195+ vaccinations delivered to at‐risk

populations (homeless and/or IV drug users)

Chula Vista Response Vaccinate

• Employee Vaccinations
• Expanded classifications that are required to receive

vaccination or decline due to occupational exposure:

• Approximately 158 vaccinations of City staff
• All sworn CPVD officers and PSOs (142) , June 2017
• Public Works/Miscellaneous (16)
• CVFD vaccinations scheduled with flu shots beginning

October 16th

• Vaccination information provided to all City staff

Library

Public Health Nurses from HHSA South Region offer Hepatitis A Vaccination at South Chula Vista Branch Library

Chula Vista Response Sanitize

• Public Works cleans restrooms on a daily basis,

using recommended sanitation guidelines.

• Additional cleaning of park facilities as needed,

including prior to scheduled special events (e.g. movies in the park)

• Handwashing stations located at 14 locations

throughout the city

Handwashing Station

Chula Vista Response Educate

• 130 Hepatitis A signs posted in all City restrooms
• Signs posted in English and Spanish
• Civic Center, Libraries, Parks, Recreation Centers, etc.
• Approximately 25 Parks staff briefed on the new

disinfection guidelines and procedures

• Increased training for all City staff on Hepatitis A

awareness

Next Steps

• HR reviewing all employee classifications that may have more regular

contact with at‐risk populations and/or contaminated trash or debris, including but not limited to:

• Custodial
• Parks maintenance
• Plumbers
• Front desk staff
• CVPD H.O.T will deploy once a week with Public Health Nurses to deliver

vaccinations (as of October 6th)

• Will continue to visit hot spots where homeless populations congregate.

Next Steps

• Distribute educational materials to Chula Vista businesses
• Explore implementation of sanitation procedures for public rights‐of‐way
• Continue with occasional static operations on an as needed basis at libraries

and homeless outreach events, like Day of H.O.P.E.

• City webpage dedicated to Hepatitis A response and education
• Provide weekly report on response operations to County of San Diego
• Keep media informed of City response

HEPATITIS A OUTBREAK SAN DIEGO COUNTY

Sayone Thihalolipavan MD, MPH Deputy Public Health Officers Health and Human Services Agency County of San Diego Regional Task Force on the Homeless October 19, 2017 Image: CDC

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HEPATITIS A, SAN DIEGO

.

*Year to date. Prepared by County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization Services, 10/16/17

613 488 645 528 447 244 302 151 169 129 77 77 88 76 64 26 19 15 38 40 15 21 26 523

100 200 300 400 500 600 700 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

All Hepatitis A Cases, San Diego County 1994 ‐ 2017*

Vaccine introduced Routine vaccination for children in high‐incidence states (including California) Routine vaccination for all U.S. children 2

YEAR LOCATION METHOD OF SPREAD/SOURCE #CASES #HOSPITA LIZATIONS #DEATHS 2003 PA & OH Food (Green Onions) 660 Unknown 3 (0.5%) 2016- 17 SAN DIEGO Close Person to Person Contact 507 351 (69%) 19 (3.7%) 2016- 17 MICHIGAN Close Person to Person Contact 397 320 (86%) 15 (4.0%) 2016 HAWAII Food (Raw Scallops) 292 74 (25%) 2013 10 states Food (Pomegranate Seeds) 165 71 (43%)

HEPATITIS A OUTBREAKS, UNITED STATES 1995 ‐ PRESENT

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HEPATITIS A, SAN DIEGO

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• 507 confirmed/probable outbreak cases
• Onset dates from 11/22/16 through 10/14/17
• 351 (69%) hospitalizations, 19 (3.7%) deaths
• 346 (68%) male, 161 (32%) female
• Age range 5-87 (median 43)
• Suspected exposure type
• 166 (33%) homeless and illicit drug use
• 83 (16%) homeless only
• 62 (12%) illicit drug use only
• 135 (27%) neither
• 61 (12%) unknown

HEPATITIS A, SAN DIEGO

• Co-infections
• 70/393 (17.8%) with hepatitis C
• 21/401 (5.2%) with hepatitis B
• 32 non-outbreak cases meet CSTE

definition (not included in count)

• 42 suspect cases under investigation
• Linked cases in other CA counties,

AZ, CO, RI, UT

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HEPATITIS A – EPI CURVE

.

Prepared by County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization Services, 10/16/17

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March 3: Outbreak recognized

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• Vaccinate
• Sanitize/Hygiene
• Educate

PUBLIC HEALTH STRATEGY

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• Local recommendations for vaccination
• 3/17: Homeless individuals
• 5/17: Homeless services providers and volunteers,

public safety workers who work with at-risk, behavioral health who work with at-risk, and selected healthcare workers who work with at-risk

• 6/17: Sanitation and janitorial workers
• 8/17: Food handlers

HEPATITIS A VACCINATION

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VACCINATE

• 71,048 total vaccines administered countywide, as of 10/07:
• 27978 given by County staff through field events (e.g., foot teams,

mobile vans, and mass vaccination clinics), jails, Tuberculosis Clinic, the County Psychiatric Hospital, and Public Health Centers;

• 43070 provided by health care systems, federally qualified health

centers, and pharmacists;

• 795 vaccinations provided as post exposure prophylaxis; and
• Implemented comprehensive strategies such as vaccinating at jail intake,

Emergency Departments, substance use disorder treatment programs, homeless service providers, and partnering with Homeless Outreach Teams.

SANITIZE (HYGIENE)

• Sanitation of streets being conducted by various

cites

• Disinfection guidance for indoor areas
• Food inspectors provide guidance information

to operators during more than 8,265 inspections

• 7,372 hygiene kits distributed
• 142 handwashing stations placed
• Working with cities to expand availability of public

restrooms

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MAP OF HANDWASHING STATIONS AND PUBLIC BATHROOMS ON 211 PAGE

http://211sandiego.

• rg/resources/healt

h-wellness

WEBSITE http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/

• mmunity_epidemiology/dc/Hepatitis_A.html.
• Posters
• Alert Notices
• Data Updates
• FAQs

EDUCATE

STATE OF EMERGENCY

California Emergency Proclamation– October 13, 2017

• Governor Brown’s emergency proclamation allows the state to use other avenues to

procure additional hepatitis A vaccines as needed to control the current outbreak.

• The proclamation gives the California Department of Public Health (CDPH) authority

to immediately purchase vaccines directly from manufacturers and distribute them to impacted communities.

• Met with all cities with more than 5 cases to discuss:
• Outbreak
• Hepatitis A case and Point in Time Count data
• Vaccination strategies (including to at-risk staff)
• Sanitation strategies
• Education strategies
• Participation in RTFH
• CAO called a meeting with all City Managers and/or delegates to

discuss the outbreak, strategies, and ongoing collaboration

COLLABORATIONS WITH CITIES

QUESTIONS ?

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For more information contact: Sayone Thihalolipavan, MD, MPH

Deputy Public Health Officer Public Health Services County of San Diego Health and Human Services Agency

3851 Rosecrans Street (MS-P578) San Diego, CA 92110 Phone: (619) 542-4916 Email: sayone.thihalolipavan@sdcounty.ca.gov

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Webpage:http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_ epidemiology/dc/Hepatitis_A.html