While thousands of new daily COVID-19 cases are showing up in Washington state, health officials say that cases of hepatitis A, a less-publicized disease that threatened the state, have apparently been beaten back thanks to vaccination efforts.

Reported cases of hepatitis A, a virus that sent 263 people to the hospital and killed nine in Washington since early 2019, have significantly declined, according to local and state public health officials, who last week declared victory in a two-and-a-half-year fight with hepatitis A in 21 Washington counties.

From the beginning of 2019 through the end of this September, a total of 199 King County residents were reported to be infected with hepatitis A, of which 122 were hospitalized. For comparison, in the nine years previous there were just five to 16 yearly cases of hepatitis A reported in King County. The number of cases seems to have returned to that baseline, according to King County’s public health department.

“This successful hepatitis A vaccination campaign is the result of years of thoughtful work among Public Health staff, partners and volunteers, who built relationships with people who are often hesitant to get vaccinated due to government and medical system disenfranchisement,” interim Director Dennis Worsham of Public Health – Seattle & King County said in a written release announcing the progress.

The liver disease, which spreads through fecal matter, represented a particular risk to homeless campers, who live outside usually without access to toilets and hand-washing stations. If someone infected with hepatitis A doesn’t wash their hands well, especially after using the toilet, undetectable amounts of the virus can spread from the hands of that person to other objects, surfaces and foods, and easily infect others. 

Most reported cases in King County were among people who were homeless or who used drugs, particularly intravenous drugs. One notably large outbreak of more than a dozen cases was in a large encampment in Ballard Commons Park.


After that outbreak last April, nonprofit leaders and homeless advocates asked the city to reopen bathrooms in libraries and public facilities that were newly closed because of COVID, even if the city had to staff them using the National Guard.

Public Health – Seattle & King County launched an aggressive vaccination campaign in homeless camps, vaccinating more than 3,500 people at almost a thousand vaccination clinics at shelters, day centers and tiny house villages. Persuading a skeptical population that often has mixed histories with medical providers required building relationships and coming back again and again. The efforts pulled in everyone from shelter providers to hospitals, community clinics, drug treatment providers and religious groups. 

“The steep decrease in hepatitis A cases and prevention of a larger outbreak locally is an excellent example of what investment in public health can accomplish,” said Dr. Jeff Duchin, the department’s health officer, in a written statement. “The hepatitis A outbreak among people living homeless was complex and required multiple, sustained labor-intensive interventions and collaboration with community stakeholders and health care system partners. I’m proud of our staff, community partners, and government leaders, and grateful to people who stepped up to get vaccinated and take other action to prevent hepatitis A from spreading.” 

Experts at public health have said the effort prepared them for the COVID vaccination push, although that will take more sustained effort. As of August, the county had vaccinated almost 6,000 homeless people against COVID, but there were at last count nearly 12,000 homeless on a given night — and that count was before COVID hit.