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 o Homeless/Drug Users o Food Handlers o Service Providers

STRATEGIC APPROACHES  Information Campaign  Valued Partnerships o County of San Diego o Target Businesses o Community Groups o Website/Social Media o Business Partners o 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 Educate Vaccinate Sanitize • Promote awareness and • Vaccinate those most at ‐ • Implement recommended provide education risk sanitation guidelines materials to employees • Vaccinate employees with • Encourage all employees • Provide local businesses exposure to at ‐ risk to practice proper and with education materials populations frequent sanitation • 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 16 th • 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 6 th ) • 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 1

All Hepatitis A Cases, San Diego County HEPATITIS A, SAN DIEGO 1994 ‐ 2017* 700 Vaccine introduced 645 613 600 Routine vaccination for children in high ‐ incidence 528 523 states (including California) 488 500 447 400 302 300 244 Routine vaccination for all U.S. children 200 169 151 129 88 100 77 77 76 64 40 38 26 26 21 19 15 15 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 . *Year to date. Prepared by County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization 2 Services, 10/16/17

HEPATITIS A OUTBREAKS, UNITED STATES 1995 ‐ PRESENT YEAR LOCATION METHOD OF #CASES #HOSPITA #DEATHS SPREAD/SOURCE LIZATIONS 2003 PA & OH Food (Green 660 Unknown 3 (0.5%) Onions) 2016- SAN Close Person to 507 351 (69%) 19 (3.7%) 17 DIEGO Person Contact 2016- MICHIGAN Close Person to 397 320 (86%) 15 (4.0%) 17 Person Contact 2016 HAWAII Food (Raw 292 74 (25%) 0 Scallops) 2013 10 states Food 165 71 (43%) 0 (Pomegranate Seeds) 3

HEPATITIS A, SAN DIEGO  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 4

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 5

HEPATITIS A – EPI CURVE March 3: Outbreak recognized . 6 Prepared by County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization Services, 10/16/17

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PUBLIC HEALTH STRATEGY  Vaccinate  Sanitize/Hygiene  Educate 9

HEPATITIS A VACCINATION  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 10

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

MAP OF HANDWASHING STATIONS AND PUBLIC BATHROOMS ON 211 PAGE http://211sandiego. org/resources/healt h-wellness 13

EDUCATE WEBSITE http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/ ommunity_epidemiology/dc/Hepatitis_A.html.  Posters  Alert Notices  Data Updates  FAQs

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.

COLLABORATIONS WITH CITIES  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

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