MELISSA BLOCK, HOST:
A deadly outbreak of hepatitis A has led the governor of California to declare a state of emergency. In San Diego County alone, more than 500 people have been infected. At least 19 have died since last November. California's homeless population has been especially hard-hit. Hepatitis A is highly contagious and thrives where sanitation is poor. It spreads through the ingestion of food and water contaminated by feces or through close contact with those infected. Dr. Nick Yphantides is chief medical officer in San Diego County, where they've responded with a vaccination and sanitation campaign.
NICK YPHANTIDES: Literally power washing the streets with water and the bleach substance that neutralizes the virus, making bathrooms more accessible, putting literal mobile hand-washing stations in certain areas. And then we've passed out almost 8,000 sanitation kits. So a whole different approach than we typically do of waiting for people to come to us.
BLOCK: And when you approach these populations and say, we're concerned you might be at risk - we'd like to vaccinate you against hepatitis A - how open have people been to that?
YPHANTIDES: Unfortunately, we know that the homeless individuals who are unsheltered and living in the street are disproportionately burdened with behavioral health challenges, mental disease, substance abuse disorders. And so if a nurse from the government shows up with a syringe and says, hey, I'm here from the government. I'm here to help you. Take this shot - it's not so simple. We have had to spend a tremendous amount of time building trust, providing education and making the case for why receiving a vaccine is such a critical opportunity for them to protect their health.
BLOCK: What are the symptoms of hepatitis A?
YPHANTIDES: These are symptoms that basically reflect inflammation of the liver. And the most common symptoms are basically fever, fatigue, nausea and vomiting, significant abdominal pain, the loss of appetite. And then one of the telltale things is either darkening of the urine or what's called jaundice, which is the common yellowing of the eyes and the yellow hue of the skin, indicating liver enzymes being spilled into the bloodstream. So jaundice is also a very common symptom.
BLOCK: Dr. Yphnatides, if you think long term about changes you would want to see made to prevent another outbreak like this in the future, where does that take you?
YPHANTIDES: Well, you know, this hepatitis outbreak to me is, like, the ultimate example of social determinants of health. One of the worst social determinants to be struggling with is not having a place to live. It is my hope that we are going to come together - not just the San Diego County but the country at large - in terms of figuring out strategies where folks can have basic needs met so as to not be at risk disproportionately for infections such as this.
BLOCK: That's Dr. Nick Yphantides. He is chief medical officer of San Diego County. Thanks so much for talking with us.
YPHANTIDES: The pleasure is my own. Thank you.
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