San Diego pharmacists provide hepatitis A vaccinations during outbreak

Everyone is being inundated with vaccine requests, Rafie says

The hepatitis A outbreak in San Diego County is being called one of the largest in U.S. history since the vaccine was introduced in the mid-1990s. As this article went to press, there have been 507 cases, 19 deaths, and 351 hospitalizations, according to San Diego County’s Health and Human Services Agency.

In early September, the county declared the outbreak a local public health emergency. It has since identified community partners, including pharmacists, to help contain the outbreak. Sally Rafie, PharmD, BCPS, said local public health officials reached out to the San Diego County Pharmacists Association because they needed help with the vaccination response.

“Everyone is being inundated with requests for this vaccine,” said Rafie, who is the association’s president.

Rafie has provided more than 750 hepatitis A vaccinations in the last month at the pharmacy-based clinic she runs inside Point Loma Shelter Island Drug in San Diego. She is aware of one other independent pharmacy involved with the hepatitis A vaccination effort. Under California law, pharmacists can provide all routine Advisory Committee for Immunization Practices’ vaccinations to patients 3 years of age and older.

Although the majority of individuals who have contacted hepatitis A during the outbreak have been people living on the streets, Rafie said she was initially tasked by the public health department to vaccinate restaurant workers who were put on the list of high-risk groups. (They have since been taken off.)

Hepatitis A, a liver infection caused by the hepatitis A virus, is highly contagious and can be transmitted to people through contaminated objects or food that someone with hepatitis A infection handled. The outbreak in San Diego started within the area’s homeless population—which is the third largest in the country. It can spread rampantly in unsanitary conditions.

“It’s bringing a lot of attention to the fact that we have a large homeless population and we don’t have adequate resources for these folks,” said Rafie, who is also a medication safety pharmacist at UC San Diego Health. Recently, the county installed portable bathrooms and handwashing stations. Nurses have also been walking the streets offering the vaccine directly to I.V. drug users and the homeless.

But a sense of urgency to get protected has filtered to the population at large in San Diego.

“There is definitely the ‘worried well’ who just want to get up to date [on the vaccine],” said Rafie. Many patients she sees in her clinic will pay out of pocket if their insurance doesn’t cover the hepatitis A vaccine. There are options for people who can’t afford the vaccine as well, and the public health department has been providing the vaccine free for certain at-risk populations.

To keep her pharmacist colleagues in San Diego informed about the outbreak, Rafie provides a weekly update through an association e-mail newsletter. She is also engaged with UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences to get students involved.