By NASEEM S. MILLER Orlando Sentinel
ORLANDO, Fla. (AP) — For more than nine months now, a group of volunteer UCF medical students have been giving free hepatitis A shots to the homeless in Orlando.
Once a month, on a Tuesday evening, they set up their portable tent and a few tables at the corner of a church parking lot in downtown Orlando and triage their patients.
They vaccinate as many as 25 people during the 90-minute clinic.
"It's a two-shot series, and we're far enough along the process that we're actually getting people coming back for their second shot," said Adams, a second-year UCF medical student. "Our clinic alone has vaccinated about 10% of the of the homeless population" in Orange County, he estimated.
The UCF students' efforts comes at a time when Florida and dozens of other states are experiencing an unprecedented outbreak of hepatitis A, a viral liver disease that is transmitted via the fecal-oral route. It can be passed on via food, if the food workers have hepatitis A and don't wash their hands, or through personal contact such as having sex or sharing drug paraphernalia.
Florida has reported more than 3,100 cases of hepatitis A this year. That's compared with about 550 cases last year and 280 cases in 2017.
Orange County has had 186 cases of hepatitis A this year, compared with 93 cases last year and 10 in 2017.
Many of the infected individuals are drug users -- both injection or non-injection drugs -- or have recently experienced homelessness. About 5% have been men who have sex with men, according to the Florida Department of Health.
By vaccinating "we're also protecting the general public. So it's a benefit not only to our patients but also the community," said Adams, 34, who worked in public health before going to medical school.
Getting a hepatitis A shot is the best way to prevent the disease. While people with health insurance and access to regular medical care might have had their hepatitis A shots, vulnerable populations are less likely to be protected against the virus.
Since the start of the outbreak last year, the state health department has launched a large vaccination campaign, reaching out to the homeless population and holding one-day vaccination events to encourage local residents to get vaccinated.
There's no treatment for the disease and it has to run its course. People with chronic liver disease and older adults with serious medical conditions are at the highest risk of developing complications from the disease.
In Florida, about 70% of the infected individuals have been hospitalized and 51 have died.
Spencer and other UCF medical students decided to give out hepatitis A shots with the help of the health department only three months after they had started the Chapman Compassionate Care for the Homeless clinic, providing skin and wound care for downtown Orlando's homeless population.
About a dozen medical students from first to fourth year show up during the clinic, to help with a range of responsibilities, from triaging patients to giving them over-the-counter medications, socks and hygiene kits. In the portable tents and under the supervision of volunteer physicians, they remove calluses, bandage wounds and refer patients to local community resources like the Health Care Center for the Homeless.
"I love this free clinic," said James, 60, who had been homeless for three years. He didn't want to share his last name to protect his privacy. "I was here about three months ago and had an issues going on with my leg and they gave me some antibiotic (cream)."
He said he was convinced that the antibiotic cream helped him discover a pea size piece of glass that was causing the problem in his leg.
The clinic started off slow. The students had to gain their patients' trust.
"The majority of the guys out here are used to feeling like the system fails them," said PJ Charles, founder and executive director of Straight Street, a program that feeds the homeless every Tuesday at the parking lot of a church in downtown Orlando. "We always say they've allowed us access into their community."
So when the students started offering hepatitis A vaccines, Charles made sure he was the first one to get a shot.
"I just went up and said, 'Look, I just got a shot,'" he said.
The clinic's popularity has gotten to a point now where "we recognize people," said Dr. Caridad Hernandez, associate professor at UCF College of Medicine and director of the Chapman Clinic.
The clinic is funded by the Jules B. Chapman, M.D. and Annie Lou Chapman Private Foundation and receives $20,000 a year for five years.
But Hernandez's goal is to eventually get a mobile unit, so that students can perform more procedures in a sterile environment and reach out to more communities.
"We're trying to form a link and try to get people to some of those services, and the more services that we can bring out here, the better," Hernandez said.
The nationwide hepatitis A outbreaks were first identified in 2016; since then 30 states have reported nearly 28,500 cases, 17,000 hospitalizations and 288 deaths, according to the CDC.
With more than 3,400 cases since last January, Florida ranks third in the nation, behind Kentucky and Ohio for the highest number of hepatitis A infections, according to the Centers for Disease Control and Prevention data. The state has also had the second highest number of deaths, behind Kentucky.
"These are our neighbors. Let's make sure that we're doing the right thing by our neighbors," said Adams.
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