State Auditor Releases Audit Report on the San Diego Hepatitis A Outbreak

Yesterday, the California State Auditor released their audit report regarding the response to San Diego’s 2017-18 hepatitis A outbreak. Recall, San Diego faced an unprecedented hepatitis A outbreak involving roughly 584 reported cases, 398 hospitalizations and 20 deaths. Amid concerns around the response to the public health crisis, lawmakers requested an audit investigating response activities of both the county and city.

The audit report stated that while the county did take early steps to intervene and contain the outbreak, the county did not set measurable targets and time frames, and did not determine needed resources, such as public health nurses, for administering vaccinations for at-risk populations. It also suggested that the county and city were delayed in implementing sanitation measures and that the county did not share timely information specific to the city causing the city to misunderstand the seriousness of the outbreak.

The State Auditor outlines recommendations for the Legislature, California Department of Public Health (CDPH), San Diego County and the City of San Diego as noted below. While all parties generally agree with the recommendations, actual responses from CDPH, San Diego County and the City of San Diego can be found here. San Diego County also continues to stand by their May 2018 Hepatitis After Action Report, which can be found here.


  • Clarify existing state law specifying that local health officers may issue directives to other governmental agencies to take actions to control the spread of communicable diseases.
  • Require health officers to make available relevant information to local public agencies including locations of concentrated cases, number of residents affected and response measures to be taken.

California Department of Public Health

  • Amend the CDPH Hepatitis A Outbreak Response Plan by February 28, 2019 to recommend jurisdictions set vaccination targets quickly, timelines for achieving those targets and determine resources needed.
  • Finalize the medical powers guide by April 30, 2019 and include to the greatest extent possible, actions local health officers can take to control the spread of communicable diseases.

San Diego County

  • Ensure response plans include specific and achievable objectives, timeframes and needed resources.
  • Update the county emergency operations plan and other documents to reflect the point above by April 30, 2019
  • Promptly convene policy groups with representatives from relevant local jurisdictions.
  • Promptly share data with relevant local jurisdictions
  • Enter MOUs with the city or negotiate revisions by March 31, 2019 to clarify the role of each entity over public health matters.

City of San Diego

  • Enter MOUs with the county or negotiate revisions by March 31, 2019 to clarify the role of each entity over public health matters.
  • Examine its actions related to the Hepatitis A outbreak prior to the emergency declaration to identify issues by March 31, 2019 and develop a corrective action plan.