With fears of hepatitis A outbreak among homeless people, King County to expand prevention

Fears of an outbreak of a highly contagious disease have prompted King County to expand free hepatitis A vaccinations for people experiencing homelessness.

The vaccinations are part of an effort to prevent an outbreak like those seen in other West Coast cities, said Jeff Duchin, health officer for Public Health — Seattle & King County. In April, King County public-health officials diagnosed hepatitis A in a homeless man, the first such case locally.

“This is not a new initiative, this is new funding,” Duchin said.

In 2017, an outbreak in San Diego that largely affected people experiencing homelessness left 20 dead and hospitalized 400. An audit found that slow response by the county in providing mass vaccinations allowed the outbreak to grow.

Several municipalities have seen hepatitis outbreaks in the recent months, including Phoenix and Boise.

The Seattle Times’ Project Homeless is funded by BECU, The Bernier McCaw Foundation, The Bill & Melinda Gates Foundation, Campion Foundation, the Paul G. Allen Family Foundation, Raikes Foundation, Schultz Family Foundation, Seattle Foundation, Seattle Mariners, Starbucks and the University of Washington. The Seattle Times maintains editorial control over Project Homeless content.

In 2018, there were 14 reported cases of hepatitis A in King County. There have been 12 cases reported this year, including the one person living on the streets.

The program will target people experiencing homelessness because they are a sizable population at an increased risk for hepatitis A outbreaks due to crowding and lack of access to sanitation, Duchin said.

“We have a large population living in conditions that are favorable to hepatitis A outbreaks,” Duchin said.

Last March, King County officials voiced concerns about outbreaks of serious diseases among people experiencing homelessness.

In the past 18 months, King County has vaccinated 2,200 people against hepatitis A, but the goal is to reach a threshold that would prevent the virus from spreading among people experiencing homelessness, Duchin said.

As of February, the Centers for Disease Control and Prevention recommends the vaccine for all people experiencing homelessness. While it is now standard for most children to receive the vaccine, this practice only began relatively recently so most adults are still at risk.

The funding will allow the public-health agency to expand services with dedicated funding for a coordinator, administrative support and four part-time vaccinators. All of the new positions have been filled and will be starting next week, if they haven’t already.

The agency will partner with existing homeless-services organizations to offer vaccination clinics and provide mobile services. They will also do rapid response to areas where people may have been exposed to hepatitis A.

The money will come from the county’s loss control program, which provides funding to address unanticipated risks. While the risks often have a liability component, they try to look at general threats faced by county programs, said Sean Catanese, the programs manager.

The idea is to preempt more expensive emergency medical costs with vaccinations, Duchin said. If demand for the vaccines outstrips what they are able to provide, they will seek additional funding from the state or county.

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