New Hampshire is in the midst of an outbreak of hepatitis A.
Since November, 142 people have been diagnosed with hepatitis A in the state and one person has died. In an average year in New Hampshire, just 7 people get the virus.
In Nashua, public health officials say a proactive approach is keeping the outbreak from getting much worse.
A Different Kind of Outbreak
In the basement of the Nashua Public Health Department, a handful of refrigerators and freezers make a constant hum. Signs taped to the doors warn to never unplug them. Inside they’re full of vaccines for diseases like the flu, chickenpox, meningitis.
Lately, more and more of the space inside the freezers has been devoted to vaccines for hepatitis A.
“Because of the hepatitis A outbreak, we’re adding hepatitis to all of our outreaches,” says Nashua public health nurse Sascha Potzka. “We’re trying to get as many people vaccinated as possible.”
Potzka says the city began preparing for a spike in hepatitis A cases months ago as they watched a wave of outbreaks spread across the country toward New Hampshire.
That wave, which dates back to at least 2017, has killed 194 people and has hospitalized more than 11,000. It reached New Hampshire last November.
Hepatitis A is a liver virus that’s transmitted when someone ingests fecal matter from someone who is infected –usually in tiny undetectable amounts. Symptoms include fever, nausea, diarrhea, and yellowing of the eyes. It’s generally less severe than hepatitis C which often becomes chronic, but it can be serious.
Unlike in previous outbreaks of hep A in the U.S., this one has not been traced to a single contaminated food source. Instead, the virus has been spreading through interpersonal contact, largely among people experiencing homelessness and/or using drugs. Potzka says that’s created its own kind of public health challenge.
“Sometimes it’s hard to find those people or to get them to trust you enough,” says Potzka, “you know a lot of them say ‘no, no, no I don’t want a vaccine.’”
That’s why Potzka is here in the basement. She’s transferring a batch of hepatitis A vaccines into a cooler so they can go on the road. To protect the people most at risk during this outbreak, the Nashua health department had decided to take the vaccines directly to them.
Knowing the Spots
Potzka and her coworker Luis Porres load the cooler into the city’s public health mobile outreach van. Then they drive to a nearby city park.
When they arrive, they put out a sign out advertising free vaccines and STD tests. When I ask why they chose this spot, Porres points to a wooded area about 100 yards back from the road.
“If you go in the back, right there in the back, it’s an ideal place for a person that is using to be alone and doing whatever they need to do,” says Porres.
Porres has worked with Nashua health department for 13 years as a community outreach worker. He knows the spots around Nashua where drug users and the city’s homeless population are likely to be found. And he’s not afraid of meeting them there to provide the public health services that might save their lives.
That approach seems to saving Nashua from the worst of this hepatitis A outbreak. So far they’ve administered more than 360 hepatitis A vaccines, and despite being in a county with 65 confirmed cases of hep A, Nashua has seen only five.
“If you know the people, it makes life easier,” says Porres.
The work isn’t going unnoticed by the people most at-risk. Omayra Jimenez is homeless, living in some woods not far from the Nashua Public Library. She says that’s where the city public health workers found her.
“They came down, we were down the trail, and they were talking about it,” says Jimenez. “I didn’t even know there was such a thing as hep A, and they told me about it so I came up and they gave me the shot. And they reminded me that I had to go back in six months and get the second one.”
Since getting vaccinated, Jimenez and her friend Sidney DeHate, who is also homeless, have been spreading the word about the outbreak – even passing out pamphlets at the soup kitchen and the local homeless shelter.
“When you live on the street and you’re at the bottom, you gotta watch everything,” says DeHate. “You gotta get as much knowledge as you can get on certain things cause you want to protect yourself.”
The state health department is recommending hepatitis A vaccines for anyone who is using recreational drugs, who is experiencing homelessness, who has recently been incarcerated, and men who have sex with other men.
Vaccines are available for little or no cost at community health centers across the state.