Vaccine rushed to Boston’s homeless after a death
Boston health officials are vaccinating hundreds of homeless people against a severe bacterial infection that can kill within hours, after a homeless man died Monday from the disease.
The victim was among three homeless men who recently came down with meningococcemia, which occurs when certain bacteria get into the bloodstream. The fatal case appears to be unrelated to the other two, which occurred in late January and involved a different strain of the bacteria, said Dr. Denise De Las Nueces, medical director of the Boston Health Care for the Homeless Program, a nonprofit agency managing the response.
“It’s not a disease that’s seen frequently in homeless people,” De Las Nueces said. “The recent cluster of three cases has been unusual. That has sparked our response. . . . Our population lives in crowded conditions in the shelters. That puts them at increased risk.”
Since 2011, Boston has seen one to five cases of the illness a year, and they were all unconnected, said Dr. Anita Barry, director of the Infectious Disease Bureau at the Boston Public Health Commission. So when three cases occurred in the same population over a short period of time, health officials grew concerned, she said.
After the third case was identified over the past weekend, Barry said, the commission decided to launch a vaccination campaign among homeless people and shelter workers as a precaution. Boston Health Care for the Homeless has also administered antibiotics to dozens of people who slept near any of the three men who were sick and to staffers who worked closely with them.
The city has sent alerts to hospitals and other medical facilities to be on the lookout for the infection, she said.
The two men who got sick in January were hospitalized but recovered.
Barry emphasized there is no threat to the general public. The culprit germs spread through saliva by kissing or sharing utensils, or are carried on a cough or sneeze. To get infected, a person would need to be within 3 to 6 feet of an ill individual for several hours, according to the Boston Public Health Commission.
Since Tuesday, Boston Health Care for the Homeless has inoculated 600 homeless people, said CEO Barry Bock. The agency plans to continue administering the vaccine, Menactra, over the next several days, focusing on people who frequent the adult shelters.
The US Centers for Disease Control and Prevention supplied 3,000 doses of Menactra, Barry said, at no cost to the city.
The illnesses are caused by a bacterium called Neisseria meningitidis, which live harmlessly in many people’s noses and throats. But the germs sometimes invade the lining of the brain and spinal cord, causing meningitis, or get into the bloodstream, causing meningococcemia.
The bloodstream illness, which all three homeless men experienced, is most severe and rapidly fatal if not recognized in time. The bacteria damage the walls of blood vessels, causing bleeding into the organs and skin, resulting in a characteristic flat, dark-purple rash. Other symptoms include fatigue, vomiting, chills, aches, rapid breathing, and diarrhea.
Barry said it is not fully understood why some people “go from carrying this in their nose to having an invasive infection,” but those who have another infection or who smoke cigarettes are at greater risk. Certain strains seem to be more likely to cause invasive disease, she said.
“In homeless shelters, especially when it’s bitterly cold, people are very close together,” Barry said. “It’s not surprising that type would be more likely to spread.”
The illness can also spread in military barracks and college dorms. Military recruits and college students are often vaccinated against it. But from time to time, cases crop up on college campuses.
Lyndia Downie, president of Pine Street Inn, said Pine Street was among the shelters that two of the sick men visited. She said antibiotics and vaccines were administered two weeks ago when the first two cases were identified and additional vaccines have been offered this week.
“Of course people were concerned,” she said. “But people responded really quickly and understood the gravity of the situation.” Nearly everyone agreed to get the shot, Downie said.
John G. Samaan, president of the Boston Rescue Mission, said the affected men had not visited his shelter. “We haven’t had any anxiety about it,” he said. But vaccinations will be offered to his clients next week, he said.