What to know about hepatitis A, as California outbreak triggers state of emergency

iStock/Thinkstock(SAN DIEGO) -- As California finds itself in the grips of the largest person-to-person hepatitis A outbreak in more than two decades, health officials are taking emergency measures to curb the spread of the deadly disease.

On Friday, California Governor Jerry Brown declared a State of Emergency in light of the outbreak that has killed at least 18 people, hospitalized 386 and infected at least 578 in the state as of this past weekend, according to the California Department of Public Health (CDPH).

"This outbreak is different than any other we have seen in the United States in the past decade," said Dr. Matt Zahn, medical director of epidemiology at the Orange County Health Care Agency. "Previously, we have seen outbreaks that are food-borne, with a direct exposure to that food source. Ongoing person-to person spread is really not something we have seen in recent years."

Also unique about this outbreak is that the homeless population and illicit drug users are the hardest hit.

Hepatitis A is a vaccine-preventable disease, and the Governor’s state of emergency proclamation has given the CDPH the authority to directly purchase vaccines from manufacturers in order to quickly distribute them to the community.

“The key is to bring the vaccination directly to the communities at risk,” Zahn said. “This population is not easy to reach, so we make interventions to bring it to them. San Diego has done a marvelous job to have their staff go out to the homeless community, individual by individual, and offer the vaccine then and there.”

The outbreaks are affecting multiple counties in California, with the San Diego Jurisdiction bearing 490 infected cases. Since early spring, more than 80,000 vaccine doses have been distributed to the public and some municipalities have purchased their own supplies. San Diego County said it has administered more than 68,500 vaccines since the outbreak began.

Sanitation and hygiene are other important aspects of controlling the spread of hepatitis A, which is spread through fecal matter. Since the outbreak began in the spring, more than 100 hand washing stations have been have been installed in the area, most of which are in the city of San Diego. The city is also power-washing areas affected public areas with bleach solutions and making public bathrooms more available in areas most frequented by the homeless.

Below are answers to commonly asked questions about this disease.

How is Hepatitis A spread?

Since this virus spreads through the feces, outbreaks are most commonly seen in the presence of unsanitary conditions or behaviors. Food workers can spread the virus if they do not properly wash their hands after using the bathroom and caregivers can transmit the virus after changing the diaper of an infected baby.

Hepatitis A can spread by simply touching objects, or through contaminated food or drinks. People may also be infected by eating uncooked food that has been contaminated, sexual contact with an infected person and travel to a country where Hepatitis A is common. The virus can be spread to others before any symptoms are apparent.

What are symptoms of Hepatitis A?

The hepatitis A virus causes inflammation of the liver. Symptoms of infection include fever, fatigue, abdominal pain, nausea and vomiting. Yellowing of the skin and eyes, also know has jaundice, is also a possible symptom of this virus.

Hepatitis A is an acute infection, with symptoms persisting for up to two months; rare cases may last longer. The virus does not typically lead to chronic infection or death, but it can prove fatal to those with compromised livers or immune systems.

How to protect against the virus

The best way to prevent getting Hepatitis A is through vaccination, given in a two-dose series, according to the U.S. Centers for Disease Control (CDC).

The vaccine is especially recommended for those at particularly increased risk, such as people with chronic liver disease, blood clotting disorders, men who have sex with men, those traveling to areas known to have the virus, such as parts of Africa and Asia, and those who could be in direct contact with people infected with hepatitis A, like health care workers.

The virus can live for months outside of the body on objects and surfaces, according to the CDC, and it can be difficult to kill.

“Hepatitis A is a hardy virus, and can certainly stay on surfaces and in the environment [for a long time],” Zahn said. Importantly, most waterless hand sanitizers and some household cleaners are not effective in destroying the virus. So when it comes to preventing spread, washing hands thoroughly and regularly with soap and water is the best bet. Using bleach-based cleaning products is the most effective to clean surfaces in a way that eliminates the hepatitis A virus.

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Woman gives birth aboard Navy's floating hospital in Puerto Rico

Purestock/Thinkstock(NEW YORK) -- The sound of two bells rang through the loud speakers of the U.S. Navy’s floating hospital on Saturday to celebrate the arrival of a newborn baby girl.

The Navy’s USNS Comfort was sailing in the vicinity of San Juan, Puerto Rico -- providing medical assistance throughout a region devastated by Hurricane Maria -- when baby Sara Victoria Llull Rodriguiz made her arrival on board.

“I never thought that our special moment would happen here on this ship,” Sara’s father, Francisco Llull Vera, said in a statement Sunday. “Everyone has been so helpful and gentle while caring for our baby. I hope this opens the door for those who still need help to seek out the Comfort.”

Vera said Sara’s 6-year-old brother Alonzo and 4-year-old sister Sofia, currently staying with family ashore in Puerto Rico, are anxiously waiting to meet her.

“They are so excited to meet her,” Sara’s mother, Tania Rodriguiz Ramos said in a statement Sunday. “It’s a huge blessing for Sara to be here. I owe everything to the doctors and nurses and everyone onboard.”

Puerto Rico Gov. Ricardo Rossello went to visit baby Sara on Sunday. He shared pictures of him cradlling the baby in his arms, with her doctor and parents standing nearby. Rossello said Sara was “the first Puerto Rican girl born” on the USNS Comfort.

The USNS Comfort, which currently has 21 people on board, has treated more than 100 patients since Maria made landfall last month, killing at least 48 people and knocking out power for most of the island.

Nearly 4 weeks after the storm hit, about 85 percent of power customers are still without electricity and about 31 of customers lack access to potable water, officials said Sunday. The death toll was raised by three over the weekend and about 111 people missing due to the storm.

Comfort Capt. Kevin Robinson said Sara, who weighed in at 6 pounds and 8 ounces, brought a sense of joy to the crew.

“I think the birth of that little girl has reinvigorated the crew,” Robinson said in a statement.

The last birth aboard Comfort occurred on Jan. 21, 2010, while the ship was providing humanitarian relief in support of Operation Unified Response following a 7.0 magnitude earthquake that caused severe damage in Haiti, according to the Navy.

The ship’s crew commemorated the occasion by ceremoniously renaming one of its two small boat tenders the “Sara Victoria.”

“We wanted to do something special, the crew has taken to the baby as one of our own,” Comfort Ship’s Master Roger Gwinn Gwinn said in a statement. “As she goes forward in life, we hope she carries Comfort with her.”

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Report: 26 million worldwide dying in pain without painkillers

iStock/Thinkstock(NEW YORK) -- The U.S. may be suffering from an opioid epidemic, but worldwide nearly 26 million people are dying in pain because they can’t access affordable palliative care.

According to a new report in The Lancet, the solution could be an off-patent three cent morphine tablet – wildly available in the United States, but often difficult to come by and much more expensive overseas.

“The pain gap is a massive global health emergency which has been ignored, except in rich countries,” says Dr. Felicia Knaul, chair of The Lancet Commission and Professor at the Leonard M. Miller School of Medicine at the University of Miami.

Of the hundreds of tons of opioid painkillers distributed worldwide, only about 4 percent of the painkillers go to low and middle-income countries.

According to Knaul, fixing the problem is straightforward, but requires governments and drug companies to work together to help the most vulnerable.

“We have the right tools and knowledge and the cost of the solution is minimal. Denying this intervention is a moral failing, especially for children and patients at the end of life,” Knaul says.

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No criminal charges in Colorado cheerleading forced-splits videos

iStock/Thinkstock(DENVER) -- Shocking videos showing high school cheerleaders in Colorado being forced into splits sparked outrage this summer, and now officials say no criminal charges will be filed.

The Denver District Attorney's Office announced the decision in a statement on Saturday following a weeks-long investigation by the Denver Police Department, which included dozens of interviews of cheerleaders from East High School, parents, school officials, and more.

One cheerleader was injured in connection with the cheerleading practice, according to the district attorney's office.

"The video of the incident involving the injured student that has been widely disseminated is painful to watch," Denver District Attorney Beth McCain said in a statement. "However, after a very thorough and careful review of all of the evidence gathered in the investigation and the statements of many members of the cheerleading squad, I have concluded that the evidence does not support the filing of criminal charges."

The videos show girls being forcibly pushed into splits, with one cheerleader crying in pain and telling the coach to stop.

The former coach, Ozell Williams, was fired after the videos went viral.  Denver Public School Disctrict officials announced the retirement of the high schools principal, Andy Mendelsberg, and the resignation of assistant principal Lisa Porter a month ago, according to ABC affiliate KMGH-TV.

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California declares state of emergency over hepatitis A outbreak

iStock/Thinkstock(LOS ANGELES) -- California has declared a state of emergency over a hepatitis A outbreak that health officials say is the largest person-to-person outbreak in the U.S. since a vaccine became available over 20 years ago.

At least 18 people have died in the outbreak that has affected San Diego, Santa Cruz, Los Angeles, and more, according to the California Department of Public Health.  Gov. Jerry Brown issued the declaration on Friday "to increase its supply of hepatitis A vaccines in order to control the current outbreak," he said in a statement.

Vaccines have already been distributed to at-risk populations in affected areas, according to the governor, but he said "additional supplies are needed."

"Today’s proclamation gives the California Department of Public Health (CDPH) authority to immediately purchase vaccines directly from manufacturers and distribute them to impacted communities," Brown said in the statement on Friday.

San Diego has had the most cases of hepatitis A (490 cases out of at least 576 reported cases), according to the CDPH.

The CDPH said on its website that most of the people infected in the outbreak are homeless, use illicit drugs (injected or non-injected), or both. 

The Hepatitis A virus is spread when the virus is ingested from contact with hands, objects, food, or drinks that have been contaminated by the feces of an infected person, according to the CDPH.  Symptoms of those infected include fever, feeling ill, yellowness of the skin, lack of appetite, and nausea, the CDPH said.

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Obesity among children, teenagers growing across the globe

iStock/Thinkstock(NEW YORK) -- Obesity among children and teenagers has risen ten-fold across the world in the past four decades, according to a new study in The Lancet.

This means more than 120 million youngsters are not at a healthy weight. The study, which is the largest of its kind, studied obesity trends in more than 200 countries from 1975 to 2016.

The largest jump in obesity levels was seen in Asia, with rates in China and India growing in recent years.

“The rising trends in children’s and adolescents’ BMI (body mass index) have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia," the study reads.

Polynesia and Micronesia have the highest rate of all; approximately half of the younger population is overweight or obese.

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Quadruplets pursue medical careers to honor late mom

Kelly Murphy(CAMDEN, N.J.) -- Toni Murphy was just 36 when she died in 2001, leaving behind five children, including 2-year-old quadruplet daughters.

Now, Toni Murphy’s quadruplet daughters, Erin, Kelly, Rachel and Casey Murphy, are 18-year-old college freshman fulfilling their mom’s legacy.

Three of the sisters are studying nursing at Rutgers University in Camden, New Jersey. Erin Murphy is studying veterinary medicine at Oklahoma State University.

Toni Murphy worked as a nurse for more than a decade before she died of complications from an infection.

“I wanted to follow in my mom’s footsteps,” Casey Murphy told ABC News. “My dad tells us stories a lot and [it was] just something that I wanted to do.”

The sisters’ father, Michael Murphy, raised the four girls and their older sister, Lyn, 31, on his own after his wife died.

“I’ve got pictures of her up around the house and would always say, ‘Your mother used to do this,’” he said of keeping Toni Murphy’s memory alive. “I kept those stories going to make sure that they knew that she was part of their lives even though they don’t remember too much of it.”

Toni Murphy worked in obstetrics and was also an elementary school nurse and a prison nurse, according to her family.

“Ever since I knew about nurses, I always just wanted to be one,” said Rachel Murphy. “Since I was little, I’ve always wanted to help people.”

Toni Murphy’s daughters each have their own dreams of what they want to do in the medical field. Kelly Murphy is considering becoming a doctor, Casey Murphy wants to work in pediatrics and find a cure for cancer, Rachel Murphy wants to be a flight trauma nurse and Erin Murphy wants to become a veterinarian.

Their older sister, Lyn Murphy, also works in the medical field as an X-ray technician in New Jersey.

"I wanted to follow in the footsteps of both of them," Kelly Murphy said of her mom and older sister. "I just had this passion for helping people and I’m really interested in the human body and how it works."

Michael Murphy said he watched his daughters fall in love with the medical field after shadowing nurses and doctors while in high school.

“It’s nice that they’ve embraced the fact that [their mom] was a nurse and wanted to honor her in that way,” Michael Murphy said. “I never forced them … they fell in love with it.”

Rachel, Casey and Kelly Murphy commute to Rutgers from their family's home in Swedesboro, New Jersey. The three sisters take the same schedule of classes and rely on the same built-in study group that helped them thrive in high school.

“I don’t think we mean to be competitive but we push each other to do the best we can and we’re always anxious to see who did the best,” Rachel Murphy said. “We don’t think of it as competitive but it just kind of happens to be that way.”

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Mother who was jailed for refusing to vaccinate son: I would 'do it all over again' 

ABC News(DETROIT) -- The Michigan mother who was sentenced to jail last week for refusing a court order to vaccinate her son -- and who has since lost primary custody of her son -- said she would "do it all over again."

"I was trying to protect my kids," Rebecca Bredow, who lives in the Detroit area, told ABC News. "I was trying to stand up for what I believed in, and it was worth it for me to try and take the risk, because I was trying to stop the vaccinations from happening."

"Never in a million years did I ever think that I would end up in jail standing up to try to protect my kids, and standing up for my beliefs," Bredow added.

She said her time in jail "was the longest five days of my life."

Despite losing primary custody of her son, spending five days in jail and the fact that her son was vaccinated anyway, Bredow said standing up for her beliefs "was worth it."

Last week, a judge sentenced Bredow to seven days in jail for refusing to bring her son's vaccinations up to date. Prior to going to jail, Bredow told ABC News that she and her then-husband, Jason Horne, had initially agreed to space out vaccinations for their young son. She and Horne separated in 2008, and she said last week that Horne now wanted their son to receive all of his vaccinations, and she refused.

There are no known benefits for children from delaying vaccines, according to the Centers for Disease Control and Prevention. Children who delay vaccines are also at risk of developing diseases during the time that they delay their vaccinations, the CDC added.

Young children also have the highest risk of developing a serious case of disease, according to the CDC. Delaying vaccines leaves children vulnerable at the time when they need the most protection from vaccines.

Bredow said her 9-year-old son's understanding of the situation is limited.

"The court has ordered that I'm not allowed to speak with him about it, which is kind of hard. He's almost 10 years old, so he understands more than the court would say I'm allowed to explain to him," Bredow said. "I don't know what his father has said to him, so I don't know what he's thinking right now."

Bredow said she has received an "overwhelming amount of support" from her community. "It's helped me get through this, truly," she added.

Benton G. Richardson, a lawyer for Bredow's ex-husband, declined ABC News' request for comment Thursday, but said in a statement last week that "this case is not truly about vaccinations."

Richardson added that Bredow and Horne have been embroiled in an ongoing legal battle, and a court sided with Horne in November 2016, ordering Bredow to vaccinate her son.

Court documents obtained by ABC News state that a court first asked Bredow to get immunizations for her son in November 2016, but state that as of September 2017, the child had not been vaccinated.

"It is our position that this case is not truly about vaccinations," Richardson said. "It is a case about Ms. Bredow refusing to comport with any number of the court's orders and actively seeking to frustrate Mr. Horne's joint legal custody rights."

Bredow denied the claims of her ex-husband's attorney.

"I have been the primary caregiver of my child since he was born. This was not leverage in any way," she said.

Bredow said she is planning on appealing and gaining back primary custody of her son.

The state of Michigan allows parents to opt out of certain vaccines for non-medical reasons. The American Academy of Pediatrics, however, emphasizes the safety and importance of vaccines in a statement on their website.

"Vaccines have been part of the fabric of our society for decades and are the most significant medical innovation of our time," the group said. "Vaccines are safe. Vaccines are effective. Vaccines save lives."

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Single case of locally transmitted Zika virus confirmed by Florida health department

iStock/Thinkstock(TAMPA, Fla.) -- A single case of locally transmitted Zika virus has been confirmed on Florida's west coast, according to the state's health department.

The isolated case occurred in Manatee County, south of Tampa and St. Petersburg, after a local couple traveled to Cuba, the Florida Department of Health said in a statement.

After the couple returned home, one partner fell ill to symptoms consistent with Zika virus infection, according to the health department. Evidence from a later investigation suggested that after that partner acquired Zika in Cuba, a mosquito in or near their home bit the infected partner and then later bit and transmitted the virus to the other partner, the health department said.

There is no evidence of an ongoing, active transmission of Zika virus to others, according to the health department.

This is the first case of locally transmitted Zika in the state this year, the department added. A total of 187 known Zika virus infections have been recorded in Florida in 2017, 107 of which were in pregnant women.

The health department has notified mosquito control, which will take measures to reduce the number of mosquitoes in the Manatee County area.

This case of Zika does not meet the requirements to establish a Zika zone, according to guidance from the U.S. Centers for Disease Control and Prevention (CDC). The health department said it will notify the public should it identify any areas of ongoing, active Zika transmission.

Health officials urged those who travel to known areas with Zika virus to use mosquito deterrents for at least three weeks after returning home, as well as condoms to reduce the risk of sexual transmission of the virus.

The health department also urged Floridians to help reduce mosquito populations near their homes and businesses by draining standing water and using repellents.

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Women vets pose for pin-up calendar to raise money for fellow vets' health care

PIN-UPS FOR VETS(CLAREMONT, Calif.) -- Nearly two dozen female veterans traded in their uniforms for sky-high heels in an effort to cheer up their fellow veterans -- and more importantly, raise money to provide financial assistance for veterans' health care needs.

Twenty-one veterans, serving a total of 145 years in all branches of the military, posed for Pin-Up for Vets 2018 calendar. The 1940s-style calendar features a weapons' instructor, a surgery technician, an intelligence officer and a military vehicle operator, among others.

The calendar, which serves as a fundraiser to help veterans' hospitals and health care programs, was started in 2006 by Gina Elise. Her grandfather served in World War II.

"At the time, there were many stories in the news about our troops coming back from Iraq, needing medical care that I felt so strongly that I wanted to do something to support our troops and veterans," she told ABC News.

Elise, 35, was inspired to create a pin-up style calendar because "pin-ups were really a symbol of hope to support troops and veterans."

Jennifer Marshall, who served in the Navy for five years, is part of the 2018 calendar.

"It was wonderful," Marshall said of the photo shoot, held on Hofer Ranch in Ontario, California, over three days last summer.

The veteran said the shoot was made even more special because she could bond with fellow service women.

She continued, "And speaking for the other ladies, everyone has expressed how much it means to them to recapture our femininity, give back to the community and have that long-lasting friendship with other veterans."

Since 2006, the calendars have raised nearly $60,000 for veteran hospitals to purchase new equipment as well as provide financial assistance for veterans. It's also help fund the non-profit organizations' "50-State VA Hospital Tour," where they hand-deliver many of the calendars to vets.

"Some of these veteran patients are in the hospital for weeks and months and they won’t have any visitors," Elise said of why she began visiting hospitals. "It’s essential to let our nation’s heroes know how much we value them."

"Undoubtedly, there are a lot of people living in this world who are in need of care, time, and attention," United States Marine Corps veteran Tess Rutherford, who is featured in the 2018 calendar, said in a statement. "But for me, I feel it is my duty ... my responsibility to extend a helping hand to my fellow veteran."

Marshall, who is now an actress living in Los Angeles, agreed. She was initially hesitant to be part of the calendar, but after being involved in Pin-Up for Vets since 2015, she is now one of the organization's most active volunteers, visiting a veterans hospital every six weeks.

"Because they mean so much," she explained. "The visits that break my heart are when veterans tell us that we are their first visitor. That is so upsetting to me. It kind of reminds us why these non-profits that go into hospitals ... are so important."

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