California hep A outbreak could prove costly to local healthcare providers

Health officials in Los Angeles County on Tuesday declared an outbreak of hepatitis A infection after two local cases were identified. Since November, the virus has killed 16 people in San Diego.

A total of 10 cases have been reported in Los Angeles County as of Tuesday, according to public health officials. Four of those people were in San Diego when they were exposed. The city has seen more than 440 confirmed cases and more than 300 hospitalizations in less than a year. In Santa Cruz County, 69 cases have been reported since April, with 33 hospitalizations.

Most of the infected cases in all three counties reportedly involved people who are either homeless or using illicit drugs—two populations known to have lower rates of insurance coverage and higher rates of emergency department visits and hospitalizations compared to national averages.

For local healthcare providers, that signals a potential spike in costs related to treating and containing the virus.

But local providers are preparing. University of California San Diego Health has been running a hepatitis A vaccination program at its free clinics as well as within one of its emergency department sites.

Those efforts over the past three months have provided vaccinations to more than 480 residents and nearly 900 of healthcare workers. The hospital confirmed it has received patients since the beginning of the outbreak, but could not provide a cost estimate. A spokeswoman said that costs related to treating a hepatitis A patient vary depending on their current or underlying condition.

But a 2012 study published in the journal Health Outcomes Research in Medicine found hepatitis A patients covered under commercial health insurance plans had "significantly higher" healthcare utilization and expenditures than non-infected patients, with an average cost per patient of $11,479 versus $5,323.

The study found hepatitis A patients over a 12-month study period had more frequent hospitalizations and emergency department visits, and averaged higher utilization of outpatient services than non-infected patients even after adjusting for factors such as age, sex, comorbidities and hepatitis A vaccination status.

The virus, which affects the liver, is most commonly spread through fecal-oral transmission, either through poor hygiene or by ingesting food or water that has been contaminated with fecal matter. The virus can also be transmitted through sexual contact or by sharing infected needles and has an incubation period of 15 to 50 days.

More than 80% of infected cases show symptoms of fever, jaundice, dark urine, loss of appetite and nausea, according to the Centers for Disease Control and Prevention. The virus can cause mild to severe illness in most cases, but can kill more medically-vulnerable patients such as the elderly or those with compromised immune systems.

San Diego health officials said 15 of the 16 deaths were caused by underlying medical conditions.

Unlike hepatitis B and C, hepatitis A is not a chronic condition. No treatment exists for the virus. Healthcare focuses on easing symptoms and managing comorbidities.

Cases of hepatitis A have declined in the U.S. by 95% since a vaccine was first introduced in 1995, but a number of outbreaks have occurred in recent years, usually stemming from contaminated food.