Health officials are ramping up efforts to stop the spread of Hepatitis A in Los Angeles County as cases begin to surge among gay and bisexual men who are not homeless.
The surge is happening during the battle against the state's massive outbreak, which has claimed 20 lives and has sickened more than 600 people, mostly in the homeless community. The outbreak started in San Diego and was reported in September.
Los Angeles County has seen 15 reported cases among those who are homeless or use recreational drugs since the outbreak began, the Los Angeles Times reported. But officials say an unrelated hepatitis A outbreak affecting the LGBT community has sickened 14 gay or bisexual men this year, compared with nine last year and one the year before.
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The Los Angeles County Health Alert Network has advised medical providers to offer Hepatitis A vaccinations to men who have sex with men, as it is the best method for preventing the infection. Providers also have been advised to offer the vaccine to homeless people.
Hepatitis A is a highly contagious liver disease that can spread easily through homeless populations because it thrives in unsanitary conditions and is primarily spread through contact with feces via surfaces or sexual contact.
A Los Angeles City Council committee approved a plan Oct. 18 for the city to consider a system of portable restrooms to address the recent outbreak. Councilman Mike Bonin introduced a motion calling on the city to explore the option, and the Homelessness and Poverty Committee approved it unanimously.
"Without access to the basic right of a restroom, people living on the streets are at a significantly increased risk of contracting diseases like hepatitis A that are spread through human feces," the motion states.
Bonin's motion would direct city staff and some agencies to report to the Homelessness and Poverty Committee on the need for additional public restrooms, including on the potential for creating a system of portable public restrooms modeled after the "Pit Stop" program in San Francisco.
The motion also seeks a report on available funding sources for emergency portable restrooms, as well the bathroom attendants that would be required to operate them.
It also would direct the city attorney to report on the city's laws regarding the placement of portable restrooms in designated locations, including city-owned parking lots.
"Opening additional public restrooms faces two challenges: funding and proper locations," the motion says.
"Best practices indicate public restrooms should be staffed by attendants to keep the facilities clean and free of criminal activity. And even if adequate funding were available, there remains a lack of adequate space in our dense neighborhoods to place restrooms without encroaching in the public right-of-way."
The Pit Stop Program is a partnership between Bay Area Rapid Transit and the city of San Francisco that provides portable public toilets at 17 locations.
Dr. Gil Chavez of the California Department of Public Health's Center for Infectious Diseases said that adding hand-washing stations and bathrooms near homeless encampments could help fight the disease.
"I think there are two keys to preventing hepatitis A -- one being vaccination, and two being good access to sanitation," Chavez said.
The state has vaccinated more than 80,000 at-risk people to try to fight the spread of the disease and Gov. Jerry Brown declared of a state of emergency back in October due to the outbreak.
A report released in June found there are only nine public toilets available at night in the Skid Row neighborhood, where roughly 1,800 homeless people sleep at night.
The lack of toilets is worse than refugees in Syria are experiencing and violate the United Nations standards of hygiene, according to the "No Place to Go" report prepared by homeless advocacy groups, including the Los Angeles Central Providers Collaborative, Los Angeles Community Action Network and the Downtown Women's Center.