Tacoma Pierce County Health Department

• Emily Less, Tacoma Pierce County Health Department – in communicable disease – consultant for many of the shelters - ELess@tpchd.org
• Want to talk about what you’ve seen in the news about communicable diseases and why vaccines are important folks who are homeless. (spoiler, but I’m guessing it is because vaccines dramatically reduce the chances of getting a disease.–ed).
• Lot of measles cases in the news – none in Pierce County or in the state in the last 40 days. People who are homeless are at low risk –because of vaccine immunity and exposure.  The immunization is called MMR (well, Measles Mumps and Rubella, actually –ed.) – it is 97% effective. 
• The mumps component isn’t as effective, but will greatly reduce severity if it doesn’t provide complete immunity. There are 5 cases of mumps in Grant County and 2 cases in Pierce County, but we are not worried about this.  There is no need to get a MMR booster. 
• Always good to talk to clients about vaccines and recommend them if folks don’t have them (unless that homeless client is Jenny McCarthy, and then good luck with that. –ed.)  
• People experiencing homelessness are at higher risk of illness and have more complications – so vaccines are really important.
• Influenza and Hepatitis A – we are very worried about those for the homeless population. They are challenging when we’re housed, but really challenging when homeless.  It is never too late to get a flu vaccine. 
• Kayla Scrivner – clinical disease program manager - KScrivner@tpchd.org
• Hepatitis A – came and talked about this a couple years ago.
• We now have confirmed cases in Washington State – none in Pierce County yet, though
• The vaccine is very important –folks who are homeless should have no trouble getting access to it.
• Hepatitis A makes people sick – we saw higher rates of hospitalization and death in the homeless population with Hepatitis A (I had a mystery liver disease when I was 12 and it totally sucked. –ed.).
• Hepatitis A spreads quickly.
• Review symptoms – encourage medical care if they have these symptoms. If you have an ill client that is refusing care – let us know.  We’ll send a MRC nurse out to give care. 
• The Plan –
  • Outreach to service providers and medical community – let folks know what symptoms to look out for
  • Planning for field teams and vaccine clinics. If we get cases, we’ll go out to sites
  • Just activated the ITS (whatever that is –ed.) to make plans if needed.
  • Will visit shelters and volunteer sites to check on cleaning plans and see if adequate wash stations are present – we aren’t regulatory, just giving advice on things (just like my Aunt Nancy -ed). We’ll be out over the next couple of weeks to do visits (unlilke my Aunt Nancy, I hope –ed.).
• Question – are you going to Project Homeless Connect to give immunizations? Yes, the Medical Reserve Corp will be there.
• Dave – For Hepatitis D , we used to have some incentivized programs. Is there something like that considered for Hepatitis A?  Kayla – we’ll talk that over in our planning meetings – get me ideas to improve our reach and our impact
• Justin – what about vaccinating children – are there resources? Kayla- in Washington State, we have Vaccines for Children that allows all kids to get them without paying.  You can do that through your medical home. 
• Emily – we are hoping you’ll encourage your clients to get vaccinated
• https://myir.net/ – can make an account, and can check their vaccine records – if you have no records, it doesn’t hurt to get another Hepatitis A or Hepatitis B vaccine (again, liver diseases suck – let’s get those vaccines, folks. –ed).
• I sent around a list of free and low cost vaccines to get resources (which I put up at http://www.pchomeless.org/Home/HealthAlert . I put it up with a yellow background to create a visual connection to the common jaundiced look of folks with compromised livers – just one of many extra services we provide our premium coalition members.  You’re welcome.  -ed.)
• Can get free vaccines at these sites (that list being at https://www.tpchd.org/home/showdocument?id=1715 ) – but getting them at their medical home is best.
• Maureen – given mobility of people – what about encampments? Kayla – on our list to engage.
• Charleen – jails? Kayla – yes, working with jails to do more vaccines while they are in the jails – these are conversations we are having.  Charleen – in the Pierce County Jail?  Kayla – working on it. 
• Homeless – I’m afraid that many people experiencing homelessness are unwilling to come forward because we’re afraid to come in to clinics. Kayla – we will work to go in to the encampments
• Maureen – can we get an update electronically about cases? Kayla – sign up for health advisories on the Tacoma Pierce County Health Department – there is a page for social service providers (https://www.tpchd.org/healthy-people/provider-resources/health-news-and-alerts  ) where you can sign up for advisories on trending issues (there are few things as trendy as hepatitis outbreaks –ed) – but  we’ll be in regular communication with the Coalition about this topic.
• We are open to feedback, and we’ll be in touch.
• David – is the Hepatitis B still a two part vaccination? Kayla – yes it is, but the first dose is very effective, so we make sure that happens, and always try to get folks the 2^nd, but clients are often hard to track down to get their second dose. 
• Maureen – not asking ID is helpful. Kayla - we collect name and DOB to record the immunization