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Hepatitis A epidemic spreads in Portland homeless encampments

Hepatitis A, a highly contagious disease, is spreading through Portland’s homeless encampments and has infected more than a dozen people in recent months.

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

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Alfredo Vergara, director of public health for the city of Portland. Ben McCanna/Photographer

There is a smaller outbreak in Androscoggin County, which has reported three cases. This comes amid an unusually high number of hepatitis A cases statewide, but the 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 linked cases of a disease.

It is a highly contagious liver infection that spreads due to unsanitary living conditions. Contaminated water, food and surfaces can all carry the disease, which originates in feces.

While advocates for the homeless say the epidemic is due to lack of access to clean water for drinking and washing, city officials say unsanitary conditions are the reason they emptied the camps and focused on welcoming people into shelters.

“Hepatitis A is a hygiene-related disease,” said Alfredo Vergara, Portland public health director. “If you don’t have access to proper toilets and soap and water, the disease will continue to spread. »

Vergara said hepatitis A outbreaks have become more common across the country and typically occur in places where people cannot maintain hygienic living conditions, such as encampments. But this is the first one he knows of in Portland.

According to data from the U.S. Centers for Disease Control and Prevention, more than 32,000 cases have been detected nationwide since 2016, mostly among people who use injection drugs or are homeless. This year, 46 cases have been identified across Maine.


Hepatitis A is easily prevented with a vaccine. Most people are vaccinated against the disease as children because they do not know how to maintain basic hygiene practices and are more likely to become infected. Adults can become susceptible to infection if they don’t get another shot, 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 the childhood vaccine becomes less effective over time.

“When you have a group of sick, unstable people who aren’t necessarily able to take care of themselves, that’s more likely to happen,” Vergara said.

Most people who get hepatitis A will have stomach pain, vomiting, and diarrhea. But for people who are immunocompromised, it can lead to hospitalization. Intravenous drug users, people infected with HIV, and those with liver disease are at higher risk of serious illness.

“Having hepatitis A is horrible no matter what, but being seriously ill and still sleeping outside, you find yourself in circumstances where you are not able to take care of yourself and sleep in a bed or d ‘access a bathroom. There are so many additional challenges,” Andrew said Volkershealth services supervisor for the nonprofit Preble Street.

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

The city had provided a garden hose for showering, but drinking water was not available. When that encampment was closed in September and many people moved to other parts of the city, including the state park and ride on Marginal Way and near Harbor View Park around Commercial Street, it There was no running water available, outreach workers said. say.

Volkers said the lack of these resources is causing the outbreak and contributing to its spread, and that conditions for homeless people in the city are worse than in the past.

“Unfortunately, this (outbreak) adds another layer to the stigma already so keenly felt. A lot of these people wish they could have showers and have access to these things, but that’s not the case,” Volkers said. “These are structural causes, but they are presented as if it is a personal problem rather than a systemic problem.”

“We completely agree that sanitation is a major problem, which is why large encampments are not healthy or safe,” city spokeswoman Jessica Grondin said Friday, adding that the city considered providing water to the Marginal Way encampment, but that this was not possible. because of the location of the fire hydrants.

“During the winter, it would be even more difficult to provide water,” she said. “That’s another reason why we’re working to get people into shelter.” »

Monday evening, the City Council is expected to vote on a proposal to allow camping through April. Some fear this will make the situation worse, while others say continuing camp cleanup only interrupts outreach work.


The city has started distributing bottled water and soap, and health workers are bringing vaccines directly to the encampments.

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

“People are pretty open to vaccines, especially when they’ve really built relationships with our staff that they trust,” Rauscher said. “They also want to ensure their safety.”

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

The city also offers walk-in vaccination hours at its Forest Avenue clinic and through the syringe services program. Rauscher says that while hepatitis A isn’t necessarily spread through sharing needles, intravenous drug users often cut their drugs with water. If this water is contaminated, it can spread disease.

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

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

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