We have been following the efforts to contain the outbreak of Hepatitis A in California. Hepatitis A virus attacks the liver, causing yellowing of the skin or eyes, diarrhea, nausea, stomach pain and fatigue. It extreme cases, it can be fatal. The pathogen is often spread through person-to-person contact and consumption of food or water contaminated with fecal matter.

The fears of public health officials that the disease would spread to other states seem to have been realized, as 2 cases linked to the San Diego outbreak have been treated in Colorado.

An outbreak of hepatitis A in Southern California raised concern among Colorado health officials after two homeless people who apparently contracted the disease in San Diego were treated here.

After the cases were reported in late summer, the Colorado Department of Health and Environment began working with homeless shelters and health clinics to vaccinate people and warn them about the danger of contracting the viral disease.

One of the cases was in El Paso County, the other was on the Western Slope, CDPHE spokeswoman Shannon Barbare said Monday.

California health officials believe that an epidemic that has infected more than 500 people statewide since March began in San Diego County, according to a report last week by The Washington Post. Nineteen people there have died from the disease, nearly all of them homeless.

The number of hepatitis A cases reported in Colorado’s general population more than doubled this year. Additionally, Michigan has 14 times more hepatitis A cases than it did last year at this time, and there have been over one dozen deaths in that state as a result of the disease.

The outbreak, which is mainly in southeast Michigan, has sickened 457 people. Of those, 370 have been hospitalized and 18 have died.

The outbreak is complicated. There’s no single source such as food contamination – and many groups of people are at risk, including homeless people, drug users, people who are neither, and now there are more cases among men who have sex with men.

Until October, only 10 men who have sex with men had contracted hep A. Then, in October, there was a sudden spike of 11 additional cases.

The state is urging doctors and hospitals to vaccinate at-risk patients, but officials say resistance is too frequently a problem.

Surprisingly, the homeless and drug users are not the most cooperative of patients. They leave the hospital before the treatment is concluded, and while they are still infectious. These individuals also often refuse to disclose the name of family, friends, and sexual contacts; therefore, public health officials have no way of contacting potentially infectious people for prophylactic treatment.

Investigations centering on the San Diego outbreak have underscored the challenges in trying to contain the disease spread.

The San Diego strain is not the one typically found in the United States, said [Dr. Monique Foster, a medical epidemiologist who runs the division of viral hepatitis for the Centers for Disease Control and Prevention], but is a strain called 1B that appears to be spreading here. It is not necessarily more virulent, she said, just hitting hard in an already weakened homeless population.

Many of the 17 hepatitis deaths occurred in people who already had liver disease, said Dr. Eric McDonald, who directs San Diego County’s Epidemiology and Immunization Services Branch. Hospitalizations occurred in many cases because victims were older and already ill or weak.

The virus has been challenging to stem because of its long, 50-day incubation period, meaning someone can be carrying and spreading it for weeks before it’s detected.

Meanwhile, in New York state, a worker at popular eatery infected at least 4 diners, and the local public health department had to round up a couple of thousand customers for free vaccines.

Nearly 1,200 more people, who were potentially exposed to Hepatitis A at Port Chester’s bartaco, were vaccinated on Saturday.

That brings the total number of treated people to about 2,900 since the Westchester County Department of Health began providing free preventive treatments at the County Center on Thursday.

…At least four people in Westchester contracted the disease as early as September, health officials said, and the commonality among them was that they all ate at the popular Port Chester restaurant.

It might be a good idea to purchase some stock in Hepatitis A manufacturing firms, as the need for its use will likely remain for quite some time.