The white van with a Florida Department of Health logo on the side pulls into the Kenwood Inn along 34th Street N in St. Petersburg, and residents begin to peer out from their front doors.
The manager emerges from the front office in shorts and flip-flops, and knocks on every door down the corridor.
“Health department here,” she calls out over the drone of rush-hour traffic.
It’s the third time this year that health officials have come to the inn, which rents rooms by the hour or the month or anything in between. Many of its residents would otherwise be on the streets, said Rachel Ilic, an environmental epidemiologist with the health department. Some have been homeless before.
The health team has come to administer free hepatitis A vaccines, part of an aggressive effort to beat back an outbreak that recently prompted Florida Surgeon General Scott Rivkees to declare a statewide emergency. The Tampa Bay area has been hit especially hard.
The region has led the state this year with 466 new hepatitis A cases in Pasco County, 369 in Pinellas County and 145 in Hillsborough County.
Pinellas health officials were the first in Florida to deploy “foot teams” into areas where the most at-risk people for hepatitis A tend to gather. They’ve administered 789 vaccines since May. Now, other counties are following suit, including Hillsborough and Pasco.
Since January 2018, Florida has recorded 3,395 cases of hepatitis A, which affects the liver and causes symptoms like fever, dark urine, yellow-tinged skin or eyes, fatigue and gastric issues. The virus is spread through contaminated feces. People pass it along by eating or drinking tainted food or water, or through sex.
Since 2016, outbreaks have hit 29 states, beginning in California and Michigan, Kaiser Health News reports. More than 25,000 cases have been reported nationally in the last year.
In the Tampa Bay area, reports of food service workers infecting others at local restaurants have dominated the news coverage about hepatitis A. Workers who handle food and don’t wash their hands after using the restroom or forgo using gloves can pass the virus onto others.
At the Kenwood Inn, Fannie Vaughn, a nurse with the Florida Department of Health in Pinellas County, raises the food handling issue with a resident who is hesitant about getting the vaccine. He’d just gotten off work and was still wearing construction boots and a dirty T-shirt.
“Do you eat at the restaurants up along 34th?” Vaughn asks. “This shot will help keep you from getting sick if someone there doesn’t wash their hands."
Vaughn has developed a knack for coaxing reluctant people out of their rooms and convincing them to get vaccinated. Ideally, people should get one shot, followed by a second one six months later. But a single shot can be effective too. The vaccination should last the rest of your life.
Aside from the shots, the foot team also hands out $10 coupons for groceries and free Narcan, a nasal spray that can treat narcotic overdose in an emergency. Vaughn brought a dozen extra to give to the motel manager.
Public health experts say the majority of hepatitis A cases come from white men in their young adult years to middle age. Most are transient, with limited access to sanitation methods and are more commonly drug users.
That’s why foot teams, fanning out multiple times a week, have visited the Kenwood Inn and many other motels that line 34th and Fourth streets in St. Petersburg, plus areas of Clearwater, Largo and Tarpon Springs.
The teams appear to be making an impact. During the peak of the hepatitis A outbreak in March, Pinellas County recorded 66 cases, said health department spokesman Tom Iovino. The number dropped to 19 cases in September and six in October.
Lynne Swain, who works in disease control at the health department, goes door-to-door at the Kenwood Inn, wheeling around a red wagon. Inside is a foam cooler to preserve the vaccines. Over her shoulder hangs a fold-out chair, which she assembles quickly when a patient agrees to get a shot. All three health department employees wear bright orange vests that read “public health”.
Kimberly Clemons has questions about the vaccine when the team arrives at her door.
“Is it going to make me sick?” she asks. She’d heard about the hepatitis A outbreak on the news.
“I got my flu shot because I know where to get that — at CVS. I didn’t know where to get this one,” says Clemons, 41, who had lived at the Kenwood Inn with her family for about a month.
She sits in the chair outside her door and holds her daughter’s hand while Vaughn administers the shot and lists the potential side effects.
“You might feel a little tired, and that’s because your body is building up immunity,” Vaughn says.
Thomas Niblack, 48, sees the team in the hallway and tries to sneak upstairs to his second-floor unit, but Swain catches him. She persuades him to come downstairs and sit.
Vaughn begins her speech about side effects all over again while she prepares the vaccine.
“This is the third time we’ve been here, and it’s taken three times to get him in the chair,” Swain says. “This is why we keep coming back.”