Public Health officials in two California counties are warning of the spread of two public health hazards – Shigella and Hepatitis A.  Each of these “bugs” – one a bacteria and one a virus – are carried in human feces.

For moral reasons we need to help make sure our fellow citizens have access to housing, good food, clean water and bathrooms.  We also need to recognize the health impacts on those same people and the financial impact on all of us due to inadequate health insurance coverage.  We also need to be aware that these “bugs’ do not stay in homeless encampments but can and do spread into the larger community. I have seen far too many Shigella and Hepatitis A linked to some of our most important, but lowest paid workers – restaurant staff.

Fixing a moral problem can also fix a public health problem.

Here are some recent announcements of an ongoing and nationwide problem.

The County of Santa Clara Public Health Department and partners continue to respond to an outbreak of Shigella among individuals experiencing homelessness in Santa Clara County. As of Monday morning, nine people have tested positive for Shigella associated with this outbreak investigation, six of them were hospitalized, and 21 more suspected cases in the county have been identified. Public Health is working with the City of San José and additional partners to prevent more people from becoming sick and to connect those who are sick to care. Public Health continues to provide guidance about the appropriate use of personal protective equipment, restroom sanitation, and safe food practices to partners working in and around encampments.

Several of the encampments are located along the Guadalupe River. Public Health outreach workers and community organizations are providing clean water and advising residents of the encampments to avoid using the river water for drinking, bathing, cooking, and toileting.

The risk to the general public remains low. Shigella can spread through water, and only a small number of individual organisms are needed to cause illness. Because infected persons have reported using the river for bathing and toileting, Public Health advises that everyone avoid using Guadalupe River water downstream of Route 85 (highway 85) – the intersection of highway 85 and Almaden Expressway. Avoid using the water for recreation, drinking, bathing, cooking, and toileting. River water is non-potable and may contain a variety of disease-causing organisms. People who come into contact with Guadalupe River water downstream of highway 85 should avoid swallowing the water and should wash with soap and water before eating or touching their face. Workers in partner organizations who might come into contact with river water in the vicinity of the encampments have been advised to wear personal protective equipment.

Shigella is a highly contagious bacteria that can cause diarrhea and sometimes severe disease. It only takes a small amount of contact (10-100 organisms) with Shigella bacteria to make someone sick, which is why it is important to respond quickly when outbreaks happen. Shigella can be spread by eating or drinking food contaminated with the bacteria or by contacting the bacteria directly from someone with a Shigella infection or from a shared surface. The infection will go away without treatment for most healthy people.

Public Health routinely monitors for cases of Shigella. It is one of many diseases and conditions required to be reported to local health departments.

The Los Angeles County Department of Public Health is investigating an outbreak of hepatitis A infections. Public Health has identified five cases among people experiencing homelessness since mid-March 2024. Hepatitis A is a highly contagious liver infection that can be spread from person-to-person even before they feel sick. The infection is caused by the hepatitis A virus, which is found in the stool and blood of people who are infected. Individuals that are unhoused are at higher risk for contracting hepatitis A infection because they often have limited access to handwashing and toileting facilities. 

Public Health is offering free hepatitis A vaccines to people experiencing homelessness in encampments and at interim housing sites where there is risk of potential exposure. Hepatitis A vaccine is typically a two dose vaccine series that is safe and highly effective in preventing infection. Additionally, previously unvaccinated people can receive hepatitis A vaccine soon after exposure to protect against developing the infection.

Public Health continues to monitor for and immediately investigate suspect hepatitis A cases. Public Health is working closely with healthcare providers to request that they remain vigilant for hepatitis A. Public Health is also working with organizations that serve people experiencing homelessness to educate the community about the increase in hepatitis A, encourage people with symptoms of hepatitis A seek medical care, and to protect themselves by getting vaccinated. 

Although the current risk to the public is low, Public Health recommends residents take the following actions to help prevent the spread of disease:

· Check if you have been vaccinated for hepatitis A. If you haven’t, contact your medical provider to determine if you should be vaccinated. Vaccination is the best way to prevent hepatitis A.

· Wash your hands with soap and water before eating and preparing food and after using the bathroom.

Hepatitis A can range from a mild illness lasting a few weeks to a severe illness lasting several months. Symptoms of hepatitis include fever, nausea, vomiting, abdominal pain, diarrhea, dark urine, or yellow eyes/skin. Although rare, hepatitis A can cause death in some people. Hepatitis A is usually transmitted through eating contaminated food, or through close contact with a person while infectious and a person with the virus can transmit illness up to two weeks prior to the onset of symptoms.

Areas with poor access to adequate water, sanitation, and hygiene services are high risk for experiencing outbreaks.