Rare infectious diseases are rising at an ‘alarming’ rate in Seattle’s homeless population, concerning health officials

King County public health officials are becoming increasingly concerned about a variety of outbreaks of serious infectious diseases among people who are homeless.

Seattle-King County Public Health is investigating outbreaks of Group A Streptococcus, shigella, and a rare group of infections transmitted by body lice among people who are homeless, as well as monitoring a potential outbreak of hepatitis A, a potentially fatal disease that spread in San Diego.

“The fact that we’re seeing multiple, different infections now increasing in the homeless population is an indicator of the sheer increase in the number of homeless people (in King County) and the fact that they’re in crowded conditions with poor hygiene and sanitation,” said Dr. Jeff Duchin, health officer for Public Health — Seattle & King County.

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At a King County Board of Health meeting Thursday, Dr. John Lynch, medical director of infection prevention and control at Harborview Medical Center, said at least two people have died since January when group A strep, which can be spread through open wounds, become necrotizing fasciitis, more commonly known as flesh-eating bacteria.

It is unclear if those cases were among people who are homeless; case reviews are ongoing. But strep A cases at Harborview nearly doubled between 2016 and 2017, to 219 cases last year, and “almost all are happening among homeless people,” Lynch said.

“It’s incredibly concerning. We’re seeing it on the front lines at Harborview,” said Lynch.

The county board of health passed a resolution Thursday urging more sanitation and hygiene services for unsheltered homeless people. At the meeting, Seattle officials described their efforts to increase toilets, hot water and hand-washing stations at the city’s six sanctioned encampments, and to bring hand-washing kits to the city’s many unsanctioned camps.

But Seattle City Councilmember Sally Bagshaw urged more such services. “This is what happens to people if you don’t have places where you can wash, get cleaned up,” she said.

In addition to strep A, public health officials issued a advisory in February about outbreaks of shigella, a highly contagious diarrheal illness, and Bartonella quintana, an infection known as “trench fever” when it spread among World War I soldiers. It is spread by body lice and can result in fevers and rashes or more serious infections of the heart or blood vessels.

There has been an average of 89 cases a year of shigella in King County since 2013, but the number of reported rose to 164 cases in 2017. Most of the cases are among people who are housed, and have been uncommon among homeless people, but there have been eight cases of among homeless people in King County since December, compared to an average of three cases per year over the past five years, according to public health data.

Three cases of Bartonella quintana have been identified among people who are homeless since mid-2017.

In addition, Lynch said the winter flu outbreak arrived a month early and hit homeless people unusually hard, and a particular strain of respiratory syncytial virus (RSV), a highly contagious virus, had spread through homeless people.

Duchin, the public health officer, emphasized that the county’s homeless population was already experiencing a health crisis, even before the uptick in these illnesses. Homeless people have life spans that are decades shorter than housed people.

“That’s alarming,” Duchin said. “Homeless people suffer from poor health across every health condition that you can imagine.”

The public health advisories in February were issued just as homeless advocates protested Seattle’s decision to reduce funding for some hygiene and emergency services for that population, as part of a structural shift in Seattle’s homeless spending.

As part of that restructuring, more emergency shelters are offering hygiene and shower facilities, but funding for stand-alone hygiene centers for homeless people was reduced until the Seattle City Council restored $1 million in funding in February.

According to last year’s one-night count, more than 5,485 homeless people were unsheltered in King County, which has doubled since 2013.

The city’s Navigation Team, which does outreach to people living in the city’s unauthorized homeless encampments, often look for conditions that could spread infectious diseases — and it’s one of the reasons the city can justify removing a camp. Needles and human waste are common in some of these camps.

Duchin noted that shigella is spread in the same was as hepatitis A, and it remains a concern in Seattle since a massive outbreak of the disease spread through California’s homeless population last fall, killing at least 21 people.

At least one case of hepatitis A has been reported in a homeless person in Seattle, but officials believe the patient had no context with homeless encampments or shelters in the region.

“The fact that we are seeing a Shigella outbreak in our population is a reminder that hepatitis A could spread just as easily if it’s introduced,” he said.