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APHA Scientific Session and Event Listing

Recorded presentation

Justin Pendarvis, MPH¹, Julia Gunn, RN, MPH¹, Donna Julius, LPN¹, Gina Etienne, RN, BSN¹, Donna Caron, RN, MSN², Pat Tormey, RN, MPH¹, and M. Anita Barry, MD, MPH¹. (1) Communicable Disease Control Division, Boston Public Health Commission, 1010 Massachusetts Ave, 2nd Floor, Boston, MA 02118, 617 534-5611, jgunn@bphc.org, (2) Communicable Disease Control, Boston Public Health Commisssion, 1010 Massachusetts Ave, Boston, Ma02118, Boston, MA 02118

Background: Outbreaks in illicit drug using populations pose unique challenges for local health departments. We report on an outbreak of Hepatitis A in Boston in 2004 that provided an opportunity to engage community partners to effectively target control measures.

Results: In 2004, the number of hepatitis A infections in Boston was 4 times higher than the average city rate in the prior 5 years.

Epidemiologic investigations identified illicit drug use (59%), homelessness (41%), and recent incarceration (16%) as characteristics associated with infection. Challenges in implementing control measures included exposure in institutional settings, limited access to health care and transient populations with minimal contact information.

Response: BPHC partnered with city agencies working with the target population and coordinated a city-wide vaccination campaign. Participating sites included the city jail, drug treatment programs, homeless shelters, an emergency department, and health centers. Vaccine was distributed to programs based on their capacity to administer vaccine and their service population. Sites with limited capacity were assisted by BPHC nurses to organize vaccination clinics that integrated with their daily operations. From September to December, over 4,500 vaccine doses were administered to at-risk individuals. Through the first four months of 2005 there was a 68% decline in reported Hepatitis A cases.

Conclusions: Partnering with city agencies working with the at-risk population allowed BPHC to reach individuals who traditionally avoid public authorities and have limited access to health services. Community partners were critical in controlling this outbreak, and the benefits of increased interconnectivity will improve future detection and response.

Learning Objectives: