Prompted by an outbreak of hepatitis A concentrated among homeless individuals, the Los Angeles County Board of Supervisors voted Tuesday to survey homeless encampments to determine where to locate more public restrooms and handwashing facilities.

Supervisor Hilda Solis recommended the survey, calling public health safety of “paramount” importance.

“Having a safe and clean area to wash your hands is a basic human rights issue,” Solis said. “The goal is to make sure that those experiencing homelessness have a clean place to maintain good hygiene and prevent illnesses from spreading.”

The outbreak was declared in September after two cases of hepatitis A were identified that could not be traced back to San Diego County or Santa Cruz. The contagion is worst in San Diego, where 490 cases and 18 deaths have been reported.

Hepatitis A is a highly contagious liver disease and the risk is particularly great among homeless individuals who are often living in unsanitary conditions, suffering from other health issues or don’t have ready access to treatment.

Venice and downtown’s Skid Row are already the focus of efforts to increase toilet, shower and handwashing options for those living on the street. The county survey will include underserved unincorporated areas, the San Gabriel Valley and riverbed encampments.

The county typically sees about 40-60 cases of hepatitis A annually from the population at large and those numbers have not increased dramatically this year, according to county health officials.

However, concerns were heightened because of 10 cases reported in homeless patients. Five confirmed cases were linked to the outbreaks in San Diego or Santa Cruz and three more cases involved workers at a health facility that could be traced back to the first five. But the source of two cases in homeless individuals could not be identified, leading to the declaration of a local outbreak.

Between Sept. 19, when the outbreak was announced and Oct. 9, two more “community-acquired” cases have been identified, according to the Department of Public Health website. Nine of the total 12 patients were hospitalized for some period of time.

Some individuals with hepatitis A may not have any symptoms, while others may suffer mild symptoms over a period of weeks that can be treated with rest, good nutrition and fluids. Most people recover completely. However, those who have other health issues or weakened immune systems can suffer permanent liver damage and even death.

The mortality rate in San Diego has been significantly higher than officials would expect. The virus is usually less deadly than the flu, killing about 1 percent of those who contract it.

Even those without symptoms can spread the disease, which mostly occurs through contact with feces via surfaces or sexual contact, so keeping hands clean is a big part of preventing contagion.

An aggressive vaccination campaign targeting homeless individuals is also underway.

A report back on potential sites for new facilities is expected in 30 days.

–City News Service

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