US communities reach out to homeless

This industrial city in central Massachusetts has had many nicknames through the years, including “the Heart of the Commonwealth” and “Wormtown.” Among them was this less-known medical moniker: “Hepatitisville.”Worcester has endured several outbreaks of the liver-battering disease, including one that sidelined 90 members of a college football team in 1969. Given its history and its size; it wasn’t surprising Worcester was hard hit when recent hepatitis A outbreaks in the state started sickening—and killing—homeless people and illicit drug users.

In this photo Worcester police officer Angel Rivera, right, asks Brian Pickering, left, if he has been tested for for Hepatitis A at the entrance to a tent where Pickering spent the night in a wooded area, in Worcester, Mass. The city was hit hard when recent hepatitis A outbreaks across the country started sickening and killing homeless people and illicit drug users.

A makeshift shelter in a wooded area

Hepatitis A outbreaks can burn themselves out after a large number of people; exposed to the virus; but vaccinations considered a crucial way to halt them faster. Public health funding has been flat or falling across much of the country; and the job of dealing with outbreaks has left to under-staffed; and cash-strapped local health departments. Outbreaks have waned in some places; but it’s not clear when the national surge will end. Some states, including Illinois and Louisiana, recently reported new outbreaks.

A decorative plaque featuring lighthouses is attached to a tree near a makeshift shelter in a wooded area, in Worcester, Mass. This industrial city in central Massachusetts has had many nicknames through the years, including “the Heart of the Commonwealth” and “Wormtown.” Among them was this less-known medical moniker: “Hepatitisville.”

“When you already have a diseased organ, adding another infection can lead to increased risk for bad outcomes” like liver failure and death, said Dr. Denise De Las Nueces. To fight the outbreaks, the CDC last month took the unusual step of recommending all U.S. homeless adults get shots to prevent hepatitis A. It was the first time the agency has targeted the homeless in a routine vaccination push.

A needle-exchange program

“We were the hepatitis D capital of the United States,” said Dr. Erik Garcia, a Worcester physician who’s been treating homeless people since 1994. There also was a 2003-2004 hepatitis A outbreak; that infected more than 1,000 people across Massachusetts; including 144 in Worcester County; mainly among the homeless and those who injected drugs. Despite that history; Worcester city officials didn’t vote to establish a needle-exchange program; until 2015—nearly two decades after the state legislature allowed such programs.

So, some homeless people and drug users in Worcester said that, they had the guidance to vaccinations by team members. Others had motivation by seeing friends and acquaintances get sick. Julie Scricco, 38, lives in a Worcester shelter and; persuaded; to have vaccination after seeing the outbreak unfold her around her. “People’s eyes were getting yellow, and puking seriously,” she said. “I didn’t want to catch it.”