Group pushes hepatitis plan

The advocates want to save costs by offering vaccinations to Hawaii's homeless

Hawaii's homeless are at high risk for contracting hepatitis A and B, whose treatment can cost more than $30,000 and last more than a year. But a $500, two-time vaccination for the infectious diseases is often not available to those on the streets.

Now, advocates and doctors -- fearing an outbreak and citing simple economics -- want to change that.

A bill moving through the state Legislature would require the state to hand out 500 hepatitis A and B vaccines to programs that help the homeless. The measure was pared down considerably from its first version, which would have given the state Department of Health an obligation to vaccinate all homeless for hepatitis A and B.

Ken Akinaka, executive director of the Hepatitis Prevention, Education, Treatment and Support Network of Hawaii, drafted the original bill. He suggested the revisions after the state Health Department voiced concerns about funding it.

"I think it's a good starting point," Akinaka said about the revised bill, adding that he is "very concerned" about the homeless at risk for hepatitis along with those who need treatment. "The main thing is that we start to vaccinate people."

Hepatitis A can spread easily among people in close contact, usually by consuming or using something that has been contaminated. Hepatitis B can be contracted through blood-to-blood exposure, including dirty needles. And both hepatitis A and B can spread through unprotected sex.

Hepatitis A, B and C attack the liver. Hepatitis B can cause cirrhosis of the liver, liver cancer and liver failure. About 5 percent of those with hepatitis C die.

In recent years there has been a slew of hepatitis outbreaks among homeless communities on the mainland, where sanitation is poor and people share food, cigarettes and other items. The most recent outbreak happened in November when about 31 homeless people in Los Angeles fell ill. Hepatitis outbreaks are also common in prisons and among children.

Akinaka said homeless with hepatitis C, which is also spread through blood-to-blood exposure, can die if they are exposed to hepatitis A. There is no vaccine for hepatitis C.

Dr. Alan Tice, a University of Hawaii infectious-disease expert, said there is a "big problem" with hepatitis among Hawaii's homeless. There are no official figures on how many are infected, but Tice said he is treating from 20 to 30 patients at any one time.

Many seek aid at the Waikiki Community Health Center, where Tice volunteers.

Tice said vaccinating the homeless for hepatitis will be a "heck of a deal" for the state as opposed to the costly and lengthy treatment for the disease, which often requires hospital stays. Tice also said that it is doubly difficult to treat the homeless because they have no permanent phone or address and sometimes miss a round of treatments.

He and Akinaka want to set up a transitional shelter for those with hepatitis.

Also, they are working on a partnership with a community health center, which they did not want to name because the details had not been worked out yet, to offer hepatitis vaccinations and treatments three days a week for about three hours each day.