California Declares Hepatitis A State of Emergency

Governor Edmund G. Brown Jr. issued an emergency proclamation that allows the state to increase its supply of hepatitis A vaccines in order to control the current outbreak.

This proclamation gives the California Department of Public Health (CDPH) authority to immediately purchase Hepatitis A vaccines directly from manufacturers.

A CDPH representative told Infectious Disease News that the overall hepatitis A case count is larger than all previous outbreaks in California over the past 20 years.

There were 7 hepatitis A outbreaks in California from 1998 to 2015, totaling 224 cases.

Dr. Gil Chavez, state epidemiologist and deputy director of the Center for Infectious Diseases at the California Department of Public Health, said “The state has already received more than 80,000 free doses from a federal “317” emergency vaccine program run by the U.S. Centers for Disease Control and Prevention.”

Dr. Chavez did not elaborate on how low the state’s supply of hepatitis A vaccine has dropped.

“The outbreak is caused by related strains of the same hepatitis A virus genotype 1b, which is not commonly seen in the Americas, but is mostly common in the Mediterranean region and in South Africa,” Chavez said.

But, Dr. Chavez said, “It is time for his department to start buying what is needed to keep existing vaccination campaigns in San Diego, Los Angeles and Santa Cruz counties supplied with as many vials as they require.”

In the USA, there are three FDA approved monovalent hepatitis A vaccines:

• Vaqta (Merck) and Havrix (GlaxoSmithKline Beecham Biologicals), are approved for people ≥12 months of age in a 2-dose series
• A combined hepatitis A and hepatitis B Twinrix, (GlaxoSmithKline) vaccine is approved for people ≥18 years of age in the United States

The CDC Vaccine Price List provides current HAV vaccine contract prices and general information.

Vaccine discounts can be found here.

The hepatitis A virus can infect the liver and cause inflammation and damage to the organ, according to the CDC. Symptoms can include dark-yellow urine, fever, joint pain, nausea and vomiting.

But in some cases, the infection can lead to liver failure, particularly in older adults or people who have other liver diseases.

PROCLAMATION OF A STATE OF EMERGENCY

• WHEREAS California is currently experiencing the largest person-to-person hepatitis A virus outbreak in the United States since the hepatitis A vaccine became available 22 years ago; and
• WHEREAS several counties have declared local outbreaks due to the unprecedented number of hepatitis A virus infections, particularly among persons experiencing homelessness and some illicit drug users; and
• WHEREAS vaccinating at-risk populations and improving sanitation are the most effective ways to stop the person-to-person spread of the hepatitis A virus; and
• WHEREAS controlling outbreaks minimizes the risk to the public, maintains the health and safety of the people of California, and limits the health risks to at-risk populations in affected locations; and
• WHEREAS the federally-funded supply of vaccines is inadequate to meet the State’s current needs, and therefore, California must directly obtain the vaccine; and
• WHEREAS sustaining the timely and effective local response will require State support to provide adequate vaccines, supplies, and resources; and
• WHEREAS under the provisions of section 8558(b) of the Government Code, I find that these circumstances constitute a state of emergency; and
• WHEREAS under the provisions of section 8571 of the Government Code, I find that strict compliance with the various statutes and regulations specified in this order would prevent, hinder, or delay the mitigation of the effects of the outbreak.
• NOW, THEREFORE, I, EDMUND G. BROWN JR., Governor of the State of California, in accordance with the authority vested in me by the state Constitution and statutes, including the California Emergency Services Act, and in particular, section 8625 of the California Government Code, HEREBY PROCLAIM A STATE OF EMERGENCY to exist in California.

IT IS HEREBY ORDERED THAT:

1. The California Department of Public Health shall take all measures necessary to obtain hepatitis A vaccines and prioritize the vaccination of at-risk individuals in affected locations.

2. All drugs and medical supply stocks intended for wholesale distribution shall be held subject to the control and coordination of the California Department of Public Health as necessary to control the hepatitis A outbreak.

3. Emergency Medical Technician-Paramedic licensees in the affected locations shall have the authority to administer the appropriate vaccines to at-risk populations. To the extent that the provisions of Health and Safety Code sections 1797.52 and 1797.21 prohibit Emergency Medical Technician-Paramedic licensees from administering the appropriate vaccines to at-risk populations, those statutes are hereby waived.

I FURTHER DIRECT that as soon as hereafter possible, this proclamation be filed in the Office of the Secretary of State and that widespread publicity and notice be given of this proclamation.

IN WITNESS WHEREOF I have hereunto set my hand and caused the Great Seal of the State of California to be affixed this 13th day of October 2017.