Reducing infectious disease risk among a vulnerable population in Los Angeles: Hepatitis A vaccination outreach with food service workers in homeless service organizations

Hepatitis A, an acute infectious disease caused by a virus, can be transmitted through the fecal-oral route by contaminated food and/or poor personal hygiene among food handlers and close contacts. In 2005-2006, a hepatitis A outbreak occurred, disproportionately affecting homeless residents and staff of homeless service organizations in downtown Los Angeles; 11% of the cases occurred in the homeless. The largest concentration of homeless persons in Los Angeles County is located in the one-square mile area known as Central City East/Skid Row (CCE/SR). To prevent further disease transmission, in 2006 the Los Angeles County Department of Public Health (LAC DPH) educated and vaccinated 88 food service workers at homeless shelters and social service providers in CCE/SR. In 2008, an interdisciplinary team from LAC DPH collaborated with ten local organizations to conduct group health education sessions, demographic and behavioral risk surveys, and vaccination outreach at six local sites. Two hundred fifty-eight food service workers, either staff or residents of homeless shelters and social service organizations, were vaccinated. Participants demonstrated significantly greater knowledge about hepatitis A after the educational session. No hepatitis A outbreaks have occurred in CCE/SR since the 2006 intervention. LAC DPH is currently developing strategies to sustain and expand hepatitis A vaccination delivery to protect more food service workers and residents of homeless service organizations. This outreach demonstrates the importance of ongoing community collaboration for infectious disease prevention and education, and repeatable methods community and health organizations can apply towards addressing health needs of disenfranchised and homeless populations.