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Hepatitis A case at Buffalo City Mission threatens outbreak among homeless

A new hepatitis A case involving a homeless person who stayed at the Buffalo City Mission has Erie County officials worried about an outbreak among Buffalo's homeless population.

The case, which was confirmed Feb. 7 after the individual visited a health facility with hepatitis A symptoms, poses a significant possibility of exposure to other homeless individuals and staff at the City Mission, as well as individuals who were on the streets from Jan. 16 to Jan. 23, officials said.

Public health officials say they are taking steps to prevent an outbreak among Buffalo's homeless, a problem that has hit other major cities.

“We have seen hepatitis A rapidly move through the homeless population in other parts of the United States,” said Dr. Gale R. Burstein, county health commissioner.

She cited outbreaks in the last year or so in areas around San Diego, Detroit, Salt Lake City and other communities.

The outbreaks are not to be taken lightly. Spread of the illness in southeast Michigan, mainly among the homeless and drug users, has led to 590 hospitalizations and 24 deaths since August 2016.

There are an estimated 5,932 homeless individuals in the Buffalo area, but given the timing and circumstances of this case, no more than 500 homeless people may have been exposed to infection, said Stuart Harper, executive director and chief executive officer of the City Mission. The mission provides 92 emergency shelter beds a night and serves 500 lunches a day.

He said the City Mission adheres to strict procedures for cleaning the facility. He also said City Mission workers receive the hepatitis A vaccine.

"We realize the challenge of the population of people we are serving, and it is a big deal to us," Harper said.

Among the steps officials are taking in the wake of a new hepatitis A case: a health clinic on Friday, personnel on the streets to alert homeless individuals, and isolation and medical treatment for the infected individual.

The clinic is scheduled for 7 to 9 a.m. and 4 to 7 p.m. in the Buffalo City Mission, 100 E. Tupper St. Treatment will only be provided to people who visited the City Mission between Jan. 24 and Feb. 4, the period of potential exposure. If appropriate, individuals will receive a vaccine or a drug known as immunoglobulin to prevent symptoms. They must be given within two weeks of exposure to be effective.

Anyone who was living on the street or was in contact with homeless individuals, especially on the city's West Side, may have also been exposed between Jan. 16 and Jan. 23, officials said. These individuals will not benefit from the vaccine or immunoglobulin.

“We’re taking a proactive approach to hopefully keep this to one case of a homeless person and ensure it doesn’t turn into an outbreak,” said County Executive Mark C. Poloncarz.

"Due to the nature of the population, this is not a low-risk situation. There is probably a higher risk of transmission," he said, noting that homeless individuals often share food, bathrooms and drugs.

The virus is usually spread when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small amounts of stool from an infected person. Unlike most recent hepatitis cases, this one is not related to a food worker.

Earlier this week, officials reported that an employee who worked at the Lancaster restaurant Al-E-Oops and the Brookdale Williamsville Senior Living Facility may have exposed 346 patrons and nursing home residents to hepatitis A. Nearly 300 people received vaccine or immunoglobulin in clinics conducted for those cases.

County: Possible hepatitis A exposure at Lancaster eatery, Amherst nursing home

The contagious hepatitis A virus that causes inflammation of the liver usually goes away on its own and can go undetected in many instances. But it also can cause mild to severe symptoms, including fever, fatigue, nausea, and jaundice, a yellowing of the skin and eyes.

Other than the vaccine, the simplest method to prevent hepatitis A is practicing good hand hygiene. That means thoroughly washing hands after using the bathroom, changing diapers and before preparing or eating food.

Reported acute hepatitis A cases in the United States have declined significantly since 1995, when a vaccine became available, from an estimated 271,000 reported cases nationally to about 2,800 cases in 2015, according to the federal Centers for Disease Control and Prevention. However, many cases go unreported.

Though there are different types of hepatitis, symptoms are similar. Here's what distinguishes hepatitis A from other common forms of this disease, according to the CDC:

  • Hepatitis A: Virus transmitted through feces, even at microscopic levels via close person-to-person contact, contaminated food and water. Can lead to acute, but not chronic infection. Resolves on its own. Much more uncommon than hepatitis B or C. Vaccine available.
  • Hepatitis B: Virus transmitted through infected bodily fluids, including blood, semen. Symptoms can range from mild illness to long-term chronic condition, most often in infants. Vaccine available.
  • Hepatitis C: A more common form of hepatitis. Virus transmitted by contact with infected blood, such as through contaminated needles. Symptoms can range from mild illness to long-term chronic condition. Chronic hepatitis is more likely to result in C than in B. No vaccine available.
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