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The Boston Globe

Metro

Boston’s lower-income areas bear brunt of flu

Socioeconomic factors hindering vaccination effort

As Boston grapples with a flu emergency that is crowding clinics and emergency rooms, the illness appears to be exacting an especially heavy toll on three neighborhoods — Dorchester, Roxbury, and Mattapan.

“This follows a pattern we see all too often across Boston and across the country where poor people and people of color are disproportionately affected by disease and illness,” said Barbara Ferrer, director of the Boston Public Health Commission, which on Wednesday declared a public health emergency as the city confronts 10 times as many confirmed flu cases compared with the same time last year.

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Myriad factors contribute to the problem.

Some low-income residents who are busy with work, including juggling multiple jobs, or who work odd hours cannot find time to get vaccinated. They are less likely to be able to afford to take time off from jobs when they become sick or want to get vaccinated, in many cases because they do not receive paid sick time and other health benefits, health specialists said.

Low-income residents are also more likely to live in densely populated households, and they commute and work in closer quarters than those from more affluent areas. Such conditions hasten the spread of illnesses.

Others might not know about the benefits of the flu vaccine, the need for a new shot each year, and that there are many ways to get the vaccine for free, even if they do not have health insurance. Some simply do not trust any immunizations.

Ferrer said the city and local health centers have been trying to overcome those barriers.

Some health centers are keeping their urgent care departments open longer hours and conducting campaigns to promote flu shots and educate residents about them.

Two dozen community health centers provided free clinics this weekend, an effort aided by free vaccines provided by the city. “Whether you’re wealthy or not wealthy, with or without insurance, and with or without sick leave, there are efforts we can take,” Ferrer said.

So far this season, Boston has had 750 confirmed cases of flu and at least five flu-related deaths. Last year, the city had only 70 confirmed cases at this time.

Since the flu season began in October, according to data provided by the city, Roxbury residents have sought care at emergency rooms for flu-like illnesses at the highest rate of any Boston neighborhood — 434 cases for every 100,000 in population.

After Roxbury was Mattapan, North Dorchester, and South Dorchester.

Meanwhile, only 106 in every 100,000 Back Bay residents have visited the emergency room for an influenza-like illness. (In the city figures, parts of the North End, Beacon Hill, and downtown were included under Back Bay.)

The only neighborhood with a lower rate is the Fenway. Ferrer said that is probably because a sizable chunk of that neighborhood’s residents — college students — have been away from the city for the past few weeks.

Frederica Williams, who runs the Whittier Street Health Center in Roxbury, said the center has been busy taking in patients with flu-like symptoms from Roxbury, Dorchester, Mattapan, and the South End. Her staff runs aggressive awareness campaigns to try to combat cultural and social misconceptions about the flu vaccine and immunizations in general.

Victor Gomes got the flu vaccine in Dorchester last week.

Aram Boghosian for The Boston Globe

Victor Gomes got the flu vaccine in Dorchester last week.

“For us it’s been around educating people that vaccines are part of wellness and prevention,” she said. “It’s not that people don’t want to take care of themselves. It’s often that people have social and economic barriers and that’s why we try to be flexible so we can meet our patients’ needs.”

At the Upham’s Corner Health Center on Thursday afternoon, patients in the waiting areas wore surgical masks. Some did so because they had flu-like symptoms; others as a means of prevention.

Among the patients was Lincell Jackson of Dorchester. The 45-year-old construction worker said he had been too busy on the job to get vaccinated earlier in the season, but when chronic neck pain sent him to the center, he took the opportunity to get vaccinated.

The number of people who have sought flu vaccines at the center had, as of Thursday, been relatively low, workers said. Since early September, 25 flu clinics had drawn a total of 370 people, according to the center’s records.

During the same stretch of 2009-2010, when the H1N1 pandemic hit, the center held 12 clinics that drew a total of 2,090 people, including one four-hour session in early November 2009 that drew 750 people.

Tarma Johnson, director of clinical services at the Mattapan Community Health Center, said as of Thursday about 500 doses had been administered there since September. Another 250 were left. With demand rising, the staff planned to try to get more.

“We’ll keep giving them out until they’re gone,” she said.

Like Jackson, many get the flu vaccine when they visit clinics for other reasons.

Ana Gomes moved to Dorchester from Cape Verde three months ago. On Thursday afternoon, she brought her 12-year-old daughter, Alene, and 8-year-old son, Victor, to the Uphams Corner Health Center so they could get physicals.

While there, each of the children received a flu vaccine.

Through a translator, the mother said in Creole that she had been sick the week before with the flu and was happy her children could have some defense against the virus.

“It all boils down to being vaccinated,” said Janette Bataringaya, director of clinical services. “We have to be mindful of taking care of ourselves.”

Matt Rocheleau can be reached atmjrochele@gmail.com.
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