Drug addiction and homelessness comprise two of the greatest challenges gateway cities like Lowell and Fitchburg face.
That's because in most circumstances, they're dealing with a population that due to drug dependency or transient lifestyle, simply can't or won't help themselves.
That's contributed to the opioid epidemic in this state. And despite some encouraging signs, that war on drug abuse still rages; deaths may be down, but the number of drug overdoses shows no signs of abating. While our ability to pre-empt fatal overdoses has improved, our success in dissuading people from taking that reckless step has not.
And that's led to an increase of another dangerous side effect of illicit drug use -- hepatitis.
Due to a sizable uptick in hepatitis A cases, the state Department of Public Health has sounded an alarm to local health officials; 65 cases of the virus have been diagnosed, leading to one death.
Hepatitis A is a viral infection that affects the liver and can cause fever, fatigue, loss of appetite, stomach pain and nausea, among other symptoms, which usually last less than two months, although some people can be ill for as long as six months, according to the CDC.
The DPH has encouraged community health departments to work with clinics and groups serving the homeless and those with substance-use disorders, especially people injecting drugs, to educate them on the risks and make vaccines available.
According to the DPH, hepatitis A is commonly transmitted through contact with food or drinks contaminated by stool, making those living in unsanitary conditions -- like tents, under bridges, or in abandoned buildings -- particularly vulnerable.
Like the opioid epidemic, this hepatitis A outbreak has spread beyond Massachusetts. It's currently also occurring in Arkansas, California, Indiana, Kentucky, Michigan, Missouri, North Carolina, Ohio, Tennessee, Utah and West Virginia.
More than 20 cases in this state were diagnosed during the first two weeks of September. Forty-five percent, or 30, of the cases detected in Massachusetts so far were in Boston, but DPH said the number of cases outside the city in the Greater Boston metro area was increasing.
Complicating the problem is the fact many of those infected have also showed signs of hepatitis C, a blood-borne infection common among intravenous drug users that can exacerbate symptoms.
The DPH is recommending vaccinations for at-risk populations and those who may come in contact with at-risk populations.
How well that message gets through will determine when this hepatitis A scare will subside. We trust the homeless that use overnight shelters like Lowell's Transitional Living Center on Middlesex Street will heed the warning and be vaccinated.
However, we're concerned about those individuals sharing needles and living in makeshift tent communities around the city.
It's going to take the combined resources of local public-health and social-service agencies to reach as many of these vulnerable individuals as possible.