- April 24, 2024
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On a recent Monday, Sue Reese spotted an older man with an unkempt beard at a gas station. He asked her politely if she had a lighter he could borrow.
Reese didn't want to assume he was homeless, regardless of appearance; she believes everyone deserves to be treated with dignity and shouldn’t be defined by a label like “homeless.” But Reese also knew she couldn’t afford to be timid. She had to know. The health of the community could be at stake if she didn’t act.
As the deadline hepatitis A virus continues to spread through the state, the Florida Department of Health has declared a state of emergency and has directed the departments of health in all 67 counties to vaccinate three populations who are at highest risk of contracting and spreading hepatitis A: homeless people, jail inmates, and anyone in drug rehab facilities. Weeks ago, Flagler was designated a high-risk county, with 12 confirmed cases.
As the planner for the Department of Health in Flagler County, Reese is tasked with leading the local effort to vaccinate as many people as possible.
In fact, earlier on that recent Monday, Reese had just been to a community meal at Santa Maria del Mar Catholic Church in Flagler Beach to vaccinate homeless people. On her way home, she stopped at a gas station and told the attendant that she had heard many homeless people use the restroom at the gas station, so it needed to be cleaned properly — and the attendants needed to wash their hands thoroughly, as well — to prevent hepatitis A from spreading.
As she was leaving, she spotted the older man with the unkempt beard. Her night was not over yet.
She struck up a conversation, ultimately leading to this key offer: She had vaccination supplies in her car. Would he be willing to be vaccinated to help prevent the deadline virus from spreading?
He hesitated.
Hepatitis is an inflammation of the liver. Although the disease was discovered centuries ago, it was only in the past several decades that the five distinct strains — A, B, C, D and E — were been identified. Hepatitis A was first isolated in 1979, and vaccines were licensed in the mid-1990s, according to the Centers for Disease Control.
The hepatitis A virus has just one natural host: humans. It’s classified as an oral-fecal disease, meaning it’s acquired by mouth and spread through feces. Therefore, a common way for the disease to spread is for someone to neglect to wash his hands after using the restroom. He then could have the virus on his hand, and if he shares a cigarette, the virus could enter another person’s mouth.
After the virus incubates for five to 10 days, the infected person could have flu-like symptoms, have tea-colored urine or gray stools. Jaundice follows within days (the person’s eyes or face could have a yellow hue).
About three of every four people who get these symptoms require hospitalization, with a fatality rate of about 1.8% for patients who are older than 50.
In parts of the world with poor sanitation, about 90% have contracted the disease at some time in their lives; in industrialized countries, the rate is 33%, according to the “Control of Communicable Diseases Manual.”
There is no cure for hepatitis A. But vaccines and hand washing prevent it.
The Florida Department of Health declared a public health emergency on Aug. 1, 2019, because of an outbreak of hepatitis A statewide. There were almost 3,000 cases reported from Jan. 1 to Oct. 31, 2019, already about six times the total in all of 2018.
In response, the state created an incident command structure, providing additional resources and requiring each county to set goals and report on progress for administering vaccinations.
“It’s an all-hands-on-deck approach,” said Bob Snyder, director of the DOH in Flagler County.
While Flagler is just recently moved into the high-risk category, Volusia County has long been one of the worst areas — fourth most hepatitis A cases in the state.
Reese feels the urgency. She is working overtime and on weekends. In the past six months, she has vaccinated more than 600 people.
To address the drug rehab patients, she has been to Project WARM (Women Assisting Recovery Mothers) multiple times. She is also developing partnerships with doctors to offer the vaccines to anyone who is prescribed Suboxone, a medication to help people stay off illegal substances. She has given vaccines to people in Drug Court.
To address the jail population, she has visited the Flagler County jail 10 times. The jail medical staff also administers the vaccine now.
To address the homeless population, she makes the rounds at several community meal sites to vaccinate the homeless population, or their friends or family who associate with them. She also seeks out the homeless on the sides of roads and in the woods, armed with vaccination supplies and a smile on her face.
“I introduce myself, tell them there’s a hepatitis A outbreak going on,” she said. “I tell them Volusia is only 10 miles away, so any people who frequent Volusia — you’re opening yourself up for the opportunity to contract it and bring it back to Flagler County.”
She explains to the patient that the first shot is 94% effective in preventing someone from contracting the disease. Six months later, they can get a second shot that will increase the effectiveness to 99%.
Because she’s been working at this for so long, people have gotten to know her. Reese’s personality has been key to the success of the program.
“She’s very transparent, engaging, approachable, friendly, professional,” Snyder said. “What a perfect skill set. … She doesn’t miss an opportunity.”
Unfortunately, it doesn’t always work, and there is much work to be done. Only about 50% of the homeless people she offers to vaccinate actually accept (that rate is more like 90% at jail, she said).
And the homeless man at the gas station?
“I can offer you the vaccine at no cost today,” she recalled tell him. “I have it in my car. Would you be interested?”
He declined.
She gave him her card and encouraged him to visit the DOH in Bunnell to get the vaccine as soon as he’s comfortable doing it. She doesn’t know whether he ever did.
But she’s not discouraged. There are others who will accept. And those who decline may accept the second or third time they’re offered. Through her words and demeanor, she hopes to convey this message: “You’re from my community. I care about you.”
She said, “My goal is for this community to be as safe as it can be by vaccinating as many people as we can.”
