Philadelphia health officials are keeping a watchful eye for any outbreaks of Hepatitis A after outbreaks have sickened people who are homeless or addicted to drugs in at least 10 states around the country.
The growing number of people living on the streets in the city’s Kensington neighborhood, a symptom of the opioid crisis, is adding to the concern. The homeless population there has nearly tripled since last year to over 700 people, with many huddled in two tunnel encampments. A city health official said conditions there, where people don’t have bathrooms or ways to wash themselves, could allow the disease to spread rapidly.
“We are taking this very seriously,” said Steven Alles, the director of disease control at the Philadelphia Department of Public Health.
The disease is usually spread through contaminated feces.
Alles said he was particularly concerned about a Hepatitis A outbreak in neighboring state West Virginia, where more than 1,300 people have been infected and two have died so far this year.
An earlier outbreak that spread through homeless encampments in San Diego last year sickened 600 people and killed 20. Laboratory analysis has linked some of the West Virginia cases to the San Diego outbreak.
Alles said Philadelphia has seen a marked increase in Hepatitis A infections in the past year, though the overall number, about 30, remains relatively small.
“We haven’t identified an injection drug user or homeless person among this trickling in of new cases,” he said.
The majority of these infections were in men who have sex with men, another higher-risk group, which Alles said suggested it was separate from the outbreaks ravaging the homeless and marginalized drug users across the country.
“We’ve done a number of outreach and community mitigation strategies to try to protect these populations from introducing it here in Philadelphia in any significant way,” he said.
Alles said the health department tested 400 people at Kensington’s Prevention Point earlier this year. They found significant rates of Hepatitis B and C, but no Hepatitis A infections. The department returned to Prevention Point over the summer and vaccinated about 100 people against Hepatitis A, Alles said.
Hepatitis A can cause severe gastrointestinal symptoms, and in the worst cases lead to liver failure and death. People already infected with Hepatitis B or C experience the worst outcomes, according to the Centers for Disease Control and Prevention.
San Diego deployed portable toilets and hand-washing stations to get the city’s outbreak under control, and sent health care workers out to vaccinate homeless people where they live.
In Minneapolis, a city that, like Philadelphia, has yet to be hit by a Hepatitis A outbreak, officials have installed portable toilets and “hand-sanitizing stations” near a major homeless encampment and begun vaccinating people there as preventative measures.
Alles said the Philadelphia health department was also considering deploying mobile vaccination teams to the Kensington encampments before the disease strikes.
“That’s on the table for us,” he said.
But bringing port-a-potties and washing stations to the camps would require the coordination of other city agencies, Alles said.
Kensington residents have said they often encounter human waste on the street since the homeless population began growing last year.
“The feces problem has been pretty bad recently,” said Amanda Fury, a member of the neighborhood association Somerset Neighbors for Better Living, which suggested providing “shower and bathroom” trucks for people at the encampments in a meeting with city officials.
When asked whether the city was considering this approach, city hall spokeswoman Alicia Taylor said, “city officials are currently meeting with neighborhood groups to get their input and are reviewing practices of other cities that are using public facilities including bathrooms and showers.”