212153 Reducing infectious disease risk among a vulnerable population in Los Angeles: Hepatitis A vaccination outreach with food service workers in homeless service organizations

Monday, November 9, 2009

Laurie M. Chow, MA , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Elaine J. Waldman , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Sandra Willman, RN, PHN , Public Health Nursing Central Health Center, Los Angeles County Department of Public Health, Los Angeles, CA
Barbara Holtwick, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Ben Techagaiciyawanis, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Ramon E. Guevara, PhD, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Roberto Avitia, RN, MS , (Formerly with) Public Health Nursing Central Health Center, Los Angeles County Department of Public Health, Los Angeles, CA
Y. Silvia Walker, RN, MSN, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Willie Watts-Troutman, RN, PHN, BSN , Immunization Program, Los Angeles County Department of Public Health, Los Angeles, CA
Elizabeth Bancroft, MD, SM , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Laurene Mascola, MD, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
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.

Learning Objectives:
Describe the rationale for providing hepatitis A vaccination to food handlers at homeless service organizations. Identify a lesson learned from a collaborative hepatitis A education and vaccination outreach intervention.

Keywords: Homeless, Community Outreach

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have assisted, contributed, and worked on this hepatitis A outreach since I joined the Los Angeles County Department of Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.