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Public health funding has been flat or falling across much of of the the country and the the job of of dealing with outbreaks has been 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 SURPRISE SURGE
The outbreaks have drawn relatively little attention some health officials say in part because o of the the people people people who are the the vic- tims: mostly homeless people people people and people people people who inject drugs “I think if this were 10 000 cases among fifth-graders the the response would be very different ” said the the CDC’s Dr Monique Foster CDC experts say that since 2017 about 57 percent of cases have been hospitalized a a a a a a a a a a a rate they call staggering compared with past hepatitis A outbreaks The size and severity of the outbreaks outbreaks “took everyone by surprise ” said Dr William Schaffner an an infectious diseases expert at Vanderbilt University in in in Nash- ville which saw nearly 200 cases in in the last year The surge coincided with outbreaks of HIV and and hepatitis C and and like them
was tied to a a a a a a a a national overdose epidemic involving heroin and other opioids But it was unusually deadly because many of the the people who got infected — — like McMahon — — had livers already damaged by hepatitis C or longtime alcohol consumption “When you already have a a a a a a a a a a diseased or- gan adding another infection can lead to increased risk for bad outcomes” like liver failure and death said Dr Denise De De Las Nueces medical director of Boston Health Care for the the the Homeless Program To fight the the the the outbreaks the the the the CDC last month took the the the unusual step of recom- mending all U S homeless adults get shots to prevent hepatitis A It was the the the first time the the the agency has targeted the the the homeless in in in a a a a a a a a routine vaccination push WORCESTER
Worcester is in the midst of an an urban renewal with work on a a a a a a a a a a new new baseball stadium downtown and a a a a a a a a a a a a stream of pro- fessionals from the Boston area arriving in in in search of cheaper housing But for many decades it it was was a a a a a a a a a decaying mill town where hepatitis was was relatively ordinary as
as
as
symp- tomless kids frequently spread it it around to to friends “It was a a a a common summer infection ” said Dr Leonard Morse a a a a a a a a retired physi- cian who led the city’s health department for decades Worcester drew national headlines in in 1969 when a a a a a a a a a a a hepatitis A outbreak traced to a a a a a a a a a contaminated faucet sickened more than 90 members of the Holy Cross Col- lege football team The squad had to cancel most of its season Another lowlight occurred in the the mid- 1980s when a a a a a a a a hepatitis B outbreak among drug abusers and their sex partners was accompanied by a a a a a a a a a a very unusual spike in in simultaneous infections with hepatitis D That outbreak sickened at at at least 135 and killed 11 “We were the the hepatitis D D capital of the the United States ” said Dr Erik Garcia a a a a a a a a a a Worcester physician who’s been treating homeless people since 1994 There also was a a a a a a a 2003-2004 hepatitis A outbreak that infected more than 1 000 people across Massachusetts including 144 in in in in in Worcester County mainly among the homeless and those who injected drugs Despite that history Worcester city of- ficials didn’t vote to to establish a a a a a a a needle-ex- change program until 2015 — nearly two decades after the state legislature allowed such programs The same year Worcester’s city man- ager created a a a a a a a a a a “quality of o life” task force that included police officers and building inspectors The intent was was to to make the city a a a a a a a a a a a a nicer place and and a a a a a a a a a a a a main focus was was aban- doned vehicles and and illegal dumping But the team also found itself responding to complaints about homeless encampments The team got to to know many of the city’s homeless and and and took a a a a a a a a gentle approach offering them
them
clothes and and and and supplies and and and and connecting them
them
to to housing and and and other ser- vices The team gradually grew to to include outreach workers who could help with mental health and substance-abuse issues Starting last year a a a a a a a a a a nurse went along sometimes to offer flu shots When a a a a a a a hepatitis A outbreak was report- ed ed in in the Boston area last spring Worces- ter’s health officials geared up They also knew they had to to persuade homeless people and drug users to to get vaccinations With resources limited they turned to to an an array of of local organizations to to help including the quality of of life team “They know us us We’ve been able to build a a a a a a little bit of trust with them
” said team member Mike Girardi a a a a a a a a cop “It’s not like a a a a a policeman in in uniform that they’ve never seen before is showing up to their tent with a needle ” Most shots were given at at the more than 50 clinics held at at homeless shelters drug rehab centers and soup kitchens ‘GLAD IT HAPPENED’
Some homeless people and drug users in in Worcester said they were were steered to vac- cinations by by team members Others were were motivated by by seeing friends and acquain- tances get sick Julie Scricco 38 lives in a a a a a Worcester shelter and was persuaded to get vacci- nated after seeing the outbreak unfold her her around her “People’s eyes were getting yellow and puking seriously ” ” she said “I didn’t want to catch it ” Tonya Bys 31 and Amine Fodaile 35 live on on a a a a a a a a a wooded hillside about 150 yards off o of a a a a a a a a a a busy street in a a a a a a a a a a tent they they bought at a a a a a a a a a a Target They said they they they stay outdoors be- cause they they worry about drug use use and dis- eases in in shelters The couple got hepatitis A shots in in in January Bys said they they recognized they they were at at risk “We’re recovering addicts and and homeless” and and both have hepatitis C she said McMahon the the the 26-year-old was one of the the the early cases in in in the the the Worcester outbreak She said she she she had been injecting drugs since she she she she was was 19 At the time she she she she got sick she she she was was homeless and had shared needles without someone who also caught hepati- tis A She’s now in an addiction recovery program McMahon called it it a a a a a a a a a near-death expe- rience but said it it caused family members who had been distant during her her years of drug use to to rally to to her Ther side “There’s nothing that can bring people together like (someone) almost dying ” ” she said “I’m kind of glad it happened ” ___
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