Hepatitis A spread among Portland’s homeless population

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

As of November 16, Portland had 18 confirmed cases, officially qualifying for an outbreak according to the Maine Center for Disease Control and Prevention. Most of these cases have been detected in homeless communities, although one case was confirmed in an employee at the Green Elephant Bistro.

There is a smaller outbreak in Androscoggin County, with three cases reported. The number of hepatitis A cases across the state is unusually high, but clusters in Portland and Androscoggin counties are the only two outbreaks, according to the Centers for Disease Control and Prevention. It defines an outbreak as three or more linked cases of the disease.

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

While homeless advocates said the outbreak stemmed from a lack of clean drinking and bathing water, city officials said they cleared encampments because of unsanitary conditions and focused on getting people into 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 water and soap, then the virus will continue to spread.”

Vergara said hepatitis A outbreaks are becoming more common across the country, often occurring in places where people cannot maintain sanitary living conditions, such as camps. But that’s what he learned for the first time in Portland.

More than 32,000 cases have been identified nationwide since 2016, mostly among people who inject drugs or are homeless, according to the U.S. Centers for Disease Control and Prevention. This year, 46 cases have been identified in Maine.

extra challenge

Hepatitis A can be easily prevented with a vaccine. Most people are vaccinated against this disease as children because they don’t know how to maintain basic hygiene and are more susceptible to infection. Adults may become susceptible to infection if they are not vaccinated again, but most people are not exposed to the disease after childhood.

However, for those who live in unsanitary conditions as adults, their chances of infection increase as childhood vaccines become less effective over time.

“That’s more likely to happen when you have a group of people who are sick and unstable and don’t necessarily have the ability to care for themselves,” Vergara said.

Most people infected with hepatitis A develop stomach pain, vomiting, and diarrhea. But for people who are immunocompromised, hospitalization may result. Intravenous drug users, people with HIV infection, and people with liver disease are at higher risk for serious illness.

“Having hepatitis A is terrible no matter what, but if you’re very sick and you’re still sleeping outside, you can’t take care of yourself, sleep in your bed or go to the bathroom. There are a lot of extra challenges,” Andrew says Volksdirector of the nonprofit Preble Street Health Services.

Portland’s outbreak dates back to mid-September, shortly after the city dismantled a homeless encampment on Fall River Parkway.

The city provided hoses for showers there, but no clean drinking water. When the camp closed in September, many moved to other areas of the city, including the State Parks and Ride parking lot on Marginal Way and near Harbor View Park around Commerce Street, where running water was no longer available, outreach workers said .

Volquez said a lack of those resources was at the root of the outbreak and contributed to its spread, and that conditions for the city’s homeless population are worse than in the past.

“Unfortunately, this (outbreak) adds another layer to the stigma that is already felt so strongly. A lot of people wish they could shower and have access to these things, but they don’t,” Volquez said. “These are structural reasons, but it’s considered an individual problem rather than a systemic problem.”

“We completely agree that sanitation is a huge issue and that’s what makes large encampments unhealthful or unsafe,” city spokesperson Jessica Grondin said Friday, adding that the city had considered Water is provided to the Marginal Way campground, but this is not possible because of the location of the fire hydrants.

“In the winter, it’s more difficult to provide water,” she said. “That’s another reason why we’re focused on getting people into shelters.”

On Monday night, the City Council is expected to vote on a proposal to allow camping through April. Some fear it will make the situation worse, while others say continuing to clear the camps will only interrupt outreach efforts.

Facing the “terrifying reality”

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

Bridget Rauscher, clinical services manager for the city’s public health department, said that’s where they’ve had the most success.

“People are pretty open to the vaccine, especially if they really have a relationship with our staff that they trust,” Rauscher said. “They also want to keep themselves safe.”

Anyone working at the camp is encouraged to get the hepatitis A vaccine.

The city is also offering vaccinations by appointment at a clinic on Forest Avenue and through a syringe service program. While hepatitis A is not necessarily spread through shared needles, intravenous drug users often use water to cut their medications, Rauscher said. If water is contaminated, it can spread disease.

Other community partners, such as Preble Street, are working to educate as many people as possible about the outbreak and encourage them to wash their hands and get vaccinated.

“Now it’s another scary reality,” Volquez said. “It’s just one more thing (homeless people) face on top of displacement, severe weather and everything else.”

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