Elizabeth Stromer, a former hospice nurse, in her home as DPW clears the encampment where she lives on 14th and Mission Streets. Photo by Lola M. Chavez

As Hepatitis A outbreaks have appeared among homeless residents elsewhere in the state, San Francisco is ramping up efforts to prevent an outbreak here by offering free vaccines to the homeless, as well as pop-up clinics and more outreach in camps this month.

Jesse Ballinger-Wydle, a homeless veteran living in SOMA, said he was unaware of the outbreak until health department workers stopped by his corner last week.

“Five years and I’ve never seen them once,” he said. “It’s about time they did something like that. They were very informative and amiable people who were truly concerned. They gave us an explanation of what was happening down south — people have died from it, and it’s an outbreak. I didn’t hesitate to take the vaccination.”

In San Diego, 17 people have died and hundreds more have fallen ill from the contagious disease. Santa Cruz county had reported 70 cases as of April, when normally it sees only one or two cases per year.

“The at-risk populations for Hepatitis A infection are homeless and drug-using communities,” Barbara Garcia, director of health in San Francisco, said in a Wednesday press release. “We are directly reaching out to these populations to provide vaccinations to ensure that we reduce the risks of a Hepatitis A outbreak in San Francisco.”

Joseph, at a SOMA homeless encampment, said he was vaccinated Tuesday during an unrelated visit to the San Francisco General Hospital emergency room.

“I don’t want Hep. It would have been stupid not to get it done,” he said. “They said there was an epidemic going around, and if I wanted the vaccination I could get it.”

Hepatitis A is a highly contagious virus that causes liver inflammation. It is spread from person to person by close contact and contaminated food. The virus is ingested by mouth from contact with hands, objects, surfaces, food or drinks that are contaminated by the feces of an infected person. Hand sanitizer is not effective — soap and water is required.

“Why it does end up hitting homeless populations has to do with the lack of access to water,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness. “Homeless people don’t have access to the basic fundamentals of health and prevention, like being able to wash your hands or take showers. We should be thinking a lot more about that as a city.”

The Health Department stepped up vaccination efforts in July of this year. As of Oct. 4, they had distributed 2,500 doses of the Hepatitis A vaccine to clinics and community organizations that serve homeless people and drug users.

A recent count of homeless individuals in San Francisco was tallied at 7,499; about half are in the Mission and South of Market neighborhoods. The count in Santa Cruz is at 2,249 this year.

“A misconception is that the homeless population is transient in nature,” Friedenbach said, citing the 2017 report produced with San Francisco’s Department of Homelessness.

Several Hepatitis A cases in Los Angeles were linked to San Diego, which caused alarm among state health departments and prompted today’s press release from Garcia.

Only eight percent of San Francisco’s homeless population has lived in the city for less than one year, while 80 percent  of Santa Cruz County’s population has lived there five years or more, according to Applied Survey Research 2017 studies in Santa Cruz and San Francisco.

The increase in street outreach and pop-up clinics are key, according to Kelley Cutler of the Coalition on Homelessness. “The benefit to going to where people are on the street or at encampments, is recognizing that they can’t leave. They can come back and all their belongings are gone. [M]eeting folks where they are living is a huge benefit.”

The Hepatitis A vaccine is free for the homeless and other at-risk populations in San Francisco. It is being made available to health care providers, community-based organizations, homeless shelters, and Navigation Centers.

The vaccine, along with other health services, will be offered at Project Homeless Connect on Oct 11, from 10 a.m. to 3 p.m., at Bill Graham Civic Auditorium.

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