Hepatitis A is spreading in homeless encampments in Portland

Hepatitis A is spreading in homeless encampments in Portland

Hepatitis A, a highly contagious disease, is spreading through homeless encampments in Portland and has infected more than a dozen people in the past few months.

As of November 16, there were 18 confirmed cases in Portland, which officially qualifies as an outbreak according to the Maine Center for Disease Control and Prevention. Most of these cases were discovered in the homeless community, although one case was diagnosed in an employee at Green Elephant Bistro.

Alfredo Vergara, Director of Public Health for the City of Portland. Ben McCanna/Staff Photographer

There is a smaller outbreak in Androscoggin County, which has reported three cases. It comes amid unusually high numbers of hepatitis A cases across the state, but clusters of cases in Portland and Androscoggin County are the only two outbreaks, according to the CDC. It defines an outbreak as three or more cases of a disease related to each other.

It is a highly contagious liver infection spread through unsanitary living conditions. Contaminated water, food, and surfaces can carry the disease, which originates in feces.

While homeless advocates say the outbreak stems from a lack of access to clean water for drinking and bathing, city officials say unsanitary conditions are the reason they evacuate encampments and focus on moving people to shelters.

“Hepatitis A is a health disease,” said Alfredo Vergara, Portland Public Health Director. “If you don’t have access to proper bathroom facilities or soap and water, it will continue to spread.”

Hepatitis A outbreaks are becoming more common across the country and are usually found in places where people cannot maintain healthy living conditions, such as camps, Vergara said. But this is the first thing he knows in Portland.

According to data from the US Centers for Disease Control and Prevention, more than 32,000 cases have been detected nationwide since 2016, especially among people who inject drugs or are homeless. This year, 46 cases have been identified throughout Maine.

Added challenges

Hepatitis A can be easily prevented by the vaccine. Most people are vaccinated against the disease as children because they do not know how to maintain basic hygiene practices and are more susceptible to infection. Adults can become susceptible to infection if they do not get another dose, but most people do not become ill after childhood.

As for those who live in unsanitary conditions as adults, their chances of infection increase because the childhood vaccine becomes less effective over time.

“When you have a sick and unstable group of people who can’t necessarily take care of themselves, this is more likely to happen,” Vergara said.

Most people who get hepatitis A will experience stomach pain, vomiting, and diarrhea. But for immunocompromised people, it can lead to hospitalization. Intravenous drug users, people with HIV and people with liver disease are more likely to develop serious illness.

“Having hepatitis A is terrible no matter what, but being so ill and still sleeping outside, you’re in circumstances where you can’t take care of yourself and sleep in bed or get to the bathroom. There are a lot of extra challenges,” Andrew said. Walkerhealth services supervisor at the non-profit Preble Street Foundation.

The outbreak in Portland dates back to mid-September, shortly after the city dismantled the Four River Parkway Trail homeless encampment.

The city had provided a hose for showering there, but clean drinking water was not available. When that camp closed in September and many people moved to other areas of the city, including the state park-and-ride lot on Marginal Road and near Harborview Park around Commercial Street, there was no longer running water available, outreach workers say.

Volkers said the lack of these resources is the root cause of the outbreak and contributes to its spread, and that conditions for the city’s homeless are worse than in the past.

“Unfortunately, this (outbreak) adds a layer to the stigma that we already feel strongly about. “A lot of these people wish they could shower and access these things but they don’t,” Volkers said. “These are structural reasons, but they are framed as if “It is a personal issue, not a systems issue.”

“We completely agree that sanitation is a big problem, and that’s why the large encampments are not sanitary or safe,” city spokeswoman Jessica Grondin said Friday, adding that the city was looking to provide water at the Marginal Way encampment but that was not possible. Because of the location of the fire hydrants.

“During the winter, it will be more difficult to provide water,” she said. “This is another reason we focus on bringing people into the shelter.”

Monday night, the City Council is expected to vote on a proposal to allow camping through April. Some worry that this will worsen the situation, while others said that continuing to clear the camps will only disrupt awareness-raising work.

“Horrible truth”

The city has begun distributing bottled water and soap, and health care workers are bringing vaccines directly to the camps.

That’s where they’ve had the most success, said Bridget Rauscher, director of clinical services for the city’s Department of Public Health.

“People are very open to vaccines, especially when they build relationships with our staff that they trust,” Rauscher said. “They want to stay safe, too.”

Anyone working in the camps is encouraged to get vaccinated against hepatitis A.

The city is also offering walk-in vaccine hours at its clinic on Forest Avenue and through its injection services program. Although hepatitis A doesn’t necessarily spread through sharing needles, intravenous drug users often douse their medications with water, Rauscher says. If that water is contaminated, it can spread disease.

Other community partners like Preble Street are trying to tell as many people as possible about the outbreak and encourage them to wash their hands and get vaccinated.

“This is another terrible reality right now,” Volkers said. “It’s just another thing that (the homeless) face on top of the displacement and the elements and everything else.”


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