King County public health officials are stepping up efforts to vaccinate people experiencing homelessness against Hepatitis A after a health care provider reported a case in mid-April, raising concerns about a potential outbreak within the homeless population.
The person who contracted Hepatitis A did not travel outside of King County in recent months, leading public health officials to believe that there are other people infected with the virus that have not yet sought treatment, said Dr. Jeffrey Duchin, health officer and chief of the Communicable Disease Epidemiology & Immunization section of Public Health — Seattle & King County.
“We’re concerned about that and we really want to sound the alarm at this point,” Duchin said.
Hepatitis A can be deadly, particularly for people without access to regular health care. Approximately 140 people have died in outbreaks since 2016.
Public Health is trying to get out in front of a potential outbreak before the disease has a chance to leave a death toll. In a recent Hepatitis A outbreak in San Diego, hundreds of people contracted the illness and 20 died. It took officials months to get the disease under control.
“By the time the San Diego authorities were able to respond, there were already a lot of cases,” said John Gilvar manager for the Health Care for the Homeless Network. “When we saw one case and we looked at the experience of San Diego and other cities we immediately activated our emergency response protocols.”
Hepatitis A is an extremely contagious virus that is primarily transmitted through the fecal-oral route, meaning that if even microscopic amounts of fecal matter make their way to the mouth due to a lack of adequate hygiene facilities, a person can contract the illness. Intravenous drug users and men who have sex with men are also among the populations with the highest risk for contracting the virus.
The virus is extremely durable and can survive for up to a month outside of the human body, said Gilvar. The incubation period is also very long, with the virus living in the body for as many as 50 days before the host starts to show symptoms.
Congregate living situations like homeless shelters are prime places for the virus to spread. The infected man stayed at the Salvation Army day center, the shelter in Seattle City Hall and a small shelter in White Center while he was contagious. According to data in the Homeless Management Information System (HMIS), as many as 500 people used those spaces around the same time.
Public Health has reached out to shelters to offer help disinfecting areas where the man had stayed while he was contagious, but the scope of the potential exposure is so vast that focusing only on those locations would not be enough to protect against a potential outbreak, Gilvar said.
“If we all thought those are the only sites that we need to worry about, we would be so wrong,” Gilvar said.
The best thing for people at risk of contracting the disease to do is get a vaccination. The vaccination prevents Hepatitis A, but it also can prevent a person who was exposed from getting the disease if the shot is given within two weeks of exposure.
Full immunization requires two shots, but the vaccine is so effective that a person can be 95 percent covered in the short term if they receive only the first of the two shots, Gilvar said. That immunity is critical to stopping an outbreak before it starts.
Public Health is distributing free vaccines for people experiencing homelessness in collaboration with the Hepatitis Education Project, the Health Care for the Homeless Network and other organizations. Health care workers gave out 77 vaccines between April 17, when they were notified about the case, and April 29 over five different clinics.
“That’s the biggest effort, biggest push right now is to offer as many opportunities for immunization as we can and to really build awareness both within people who are themselves experiencing homelessness and people who work with homeless people,” Gilvar said.
Get a free Hepatitis A vaccine at the following walk-in locations (open Monday through Friday during the day except where noted):
Pioneer Square Clinic, 206 Third Ave. S
Third Ave Center, 2028 3rd Ave. (next to Angeline’s Day Center)
Boren Clinic, 1930 Boren Ave. (mornings only)
Robert Clewis Needle Exchange, 2124 Fourth Ave. (also open Saturday, 2-4 p.m.)
Downtown Public Health Clinic, 2124 Fouth Ave.
Hepatitis Education Project, 1621 S Jackson St. (open Tuesday and Thursday 1-5 p.m., or by appointment)
Ballard NeighborCare Clinic, 1753 NW 56th St., 45th St. Youth Clinic (ages 12-26): 1629 N 45th St. (Open Wednesday and Thursday, 6-9 p.m.)
Mobile Medical Van, various locations, check their website for up-to-date information
Public Health Eastgate Primary Care, Family Planning Clinic, 14350 SE Eastgate Way, Bellevue
South King County
Public Health at Navos, 1210 SW 136th St., Burien
Auburn Public Health Clinic, 901 Auburn Way N, Suite A, Auburn
Federal Way Public Health Clinic, 33431 13th Place S, Federal Way
Kent Public Health Clinic, 25742 104th Ave SE, Kent
HealthPoint Kent Urgent Care, 219 State Ave. N, Kent
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Follow Ashley on Twitter @AshleyA_RC
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