Homelessness in the greater Seattle/King County region seems to be rising as fast as High-Tech jobs and housing prices. There are estimated to be 3,000 people in Seattle each night who are unsheltered and about 10,000 homeless people living on either the streets or in shelters. And, as the nights grow wetter and colder, the lives of our fellow citizens grow even more precarious. Clearly, homelessness is a complex issue that combines various elements of poverty, substance abuse and mental health, however, now, enters yet another concern – public health – specifically, the growing risk of hepatitis A amongst the homeless, and the risk that it will spread.
It is what is happening in other regions and the risk that it could happen here is real.
In the Detroit, Michigan area there have been 486 cases of hepatitis A, including 19 fatalities, identified as related to an outbreak in Southeast Michigan, according to the Michigan Department of Health and Human Services. In October, health officials said they were investigating cases at Firewater Bar and Grill and a Little Caesars Pizza location in Detroit and a restaurant worker in Ann Arbor. Cases were also linked to Whole Foods in Detroit and Social Kitchen in Birmingham and recently at Champs Rotisserie and Spirits in Wayne County.
In San Diego, California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th, the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.
And, thanks to the Huffington Post, you can see the problem in the whole country:
Hepatitis A is preventable with a vaccine and/or good sanitation and/or handwashing. Hepatitis A is a communicable — or contagious — disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.
Hepatitis A is relatively stable and can survive for several hours on fingertips and hands. It can live up to two months on dry surfaces. The virus can be inactivated by heating to 185 degrees F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. Freezing does not kill the virus.
The vaccine is recommended by public health officials for the following people:
- Travelers to areas with increased rates of hepatitis A;
- Men who have sex with men;
- Injecting and non-injecting drug users;
- Persons with clotting factor disorders;
- Persons with chronic liver disease;
- Persons with occupational risk of infection;
- Children living in regions of the U.S. with increased rates of hepatitis A; and
- Household members and other close personal contacts.
So, what can we do to prevent the tragedies that have hit California and Michigan hard and appear to be spreading to other areas of the country?
- Encourage and offer hepatitis A vaccines to the homeless and other at-risk members of the public;
- Provide sanitary bathroom and handwashing facilities to the homeless; and
- Provide assistance to our neighbors to deal with the underlying issues of poverty, substance abuse and mental health.