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Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024; 139:532-548. [PMID: 38379269 PMCID: PMC11344984 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
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Affiliation(s)
- Caroline J. Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S. Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M. Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A. Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K. Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C. Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Barnes J, Segars L, Wasserman JA, Karabon P, Taylor TAH. Comparative treatment of homeless persons with an infectious disease in the US emergency department setting: a retrospective approach. J Epidemiol Community Health 2024:jech-2023-220572. [PMID: 39164079 DOI: 10.1136/jech-2023-220572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/29/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Research has long documented the increased emergency department usage by persons who are homeless compared with their housed counterparts, as well as an increased prevalence of infectious diseases. However, there is a gap in knowledge regarding the comparative treatment that persons who are homeless receive. This study seeks to describe this potential difference in treatment, including diagnostic services tested, procedures performed and medications prescribed. METHODS This study used a retrospective, cohort study design to analyse data from the 2007-2010 United States National Hospital Ambulatory Medical Care Survey database, specifically looking at the emergency department subset. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. Findings were then adjusted for potential confounding variables. RESULTS Compared with private residence individuals, persons who are homeless and presenting with an infectious disease were more likely (adjusted OR: 10.99, CI 1.08 to 111.40, p<0.05) to receive sutures or staples and less likely (adjusted OR: 0.29, CI 0.10 to 0.87, p<0.05) to be provided medications when presenting with an infectious disease in US emergency departments. Significant differences were also detected in prescribing habits of multiple anti-infective medication classes. CONCLUSION This study detected a significant difference in suturing/stapling and medication prescribing patterns for persons who are homeless with an infectious disease in US emergency departments. While some findings can likely be explained by the prevalence of specific infectious organisms in homeless populations, other findings would benefit from further research.
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Affiliation(s)
- Jessica Barnes
- Family Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Larry Segars
- Basic Sciences, Kansas City University, Kansas City, Missouri, USA
| | - Jason Adam Wasserman
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Tracey A H Taylor
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Boodman C, Lindsay LR, Dibernardo A, Kisil K, Coatsworth H, Huynh C, Heendeniya A, Schellenberg J, Keynan Y. Body Louse Pathogen Surveillance among Persons Experiencing Homelessness, Canada, 2020-2021. Emerg Infect Dis 2024; 30:1450-1453. [PMID: 38916637 PMCID: PMC11210640 DOI: 10.3201/eid3007.231660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
We analyzed body lice collected from persons experiencing homelessness in Winnipeg, Manitoba, Canada, during 2020-2021 to confirm vector species and ecotype and to identify louseborne pathogens. Of 556 lice analyzed from 7 persons, 17 louse pools (218 lice) from 1 person were positive for the louseborne bacterium Bartonella quintana.
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Anthonj C, Stanglow SN, Grunwald N. Co-defining WASH (In)Security challenges among people experiencing homelessness. A qualitative study on the Human Right to Water and Sanitation from Bonn, Germany. Soc Sci Med 2024; 342:116561. [PMID: 38237319 DOI: 10.1016/j.socscimed.2024.116561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Access to safe and affordable drinking water, sanitation and hygiene (WASH) for all is needed to safeguard human health, high on societal and political agendas. According to official estimates, populations in high-income countries (HICs) are well served. Vulnerable communities at the margins of rich societies, including people experiencing homelessness, however, are often underserved and overlooked. For them, safe WASH is often a dream rather than reality. To date, no study has been conducted in Germany - one of the countries most affected in Europe. METHODS We chose a qualitative mixed-method approach to understand WASH (in)security challenges that people experiencing homelessness are facing. Data were collected in Bonn, Germany, from 25 people experiencing homelessness (in-depth interviews, arts-based workshops, group discussions), their service providers (social workers), and (un)available public infrastructure (inspections), in 2023. Data were analyzed following the dimensions of the Human Right to Water and Sanitation (HRTWS): availability; accessibility; affordability; acceptability; quality and safety. RESULTS People experiencing homelessness largely lack available, accessible, affordable, acceptable and safe WASH. Open urination and defecation are often the only alternative, resulting in substantial health risks and diseases. Women face particular challenges, especially while menstruating. Extreme weather events complicate existing WASH insecurity further, creating additional hardships for unhoused people and their service providers. The missed realization of the HRTWS has far-reaching consequences, making it harder to transition out of homelessness. CONCLUSIONS Much remains to be done to serve unhoused people in HICs better with WASH. Their experiences shed light on the underlying complexities, and the implications of different often interconnected challenges, including instability, mobility, preexisting diseases, mental health conditions and substance use disorder. Different insecurities exist among different sub-groups (e.g. women, people with limited mobility). They are valuable key informants for targeted health messaging and interventions.
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Affiliation(s)
- C Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - N Grunwald
- Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Kamani J, Nachum-Biala Y, Bukar L, Shand M, Harrus S. Molecular detection of Bartonella quintana, Acinetobacter baumannii and Acinetobacter haemolyticus in Pediculus humanus lice in Nigeria, West Africa. Zoonoses Public Health 2024; 71:48-59. [PMID: 37787179 DOI: 10.1111/zph.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/18/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
The human lice Pediculus humanus is distributed worldwide but, it thrives and flourishes under conflict situations where people are forced to live in crowded unhygienic conditions. Molecular methods were used to identify and screen human lice for the DNA of pathogens of public health importance in an area that has been under insurgency related to religious and political conflicts with tens of thousands of internally displaced people (IDP). DNA of Bartonella quintana, Acinetobacter baumannii and Acinetobacter haemolyticus was detected in 18.3%, 40.0% and 1.7%, respectively, of human lice collected from children in Maiduguri, Nigeria. More body lice than head lice were positive for pathogen's DNA (64.3% vs. 44.4%; χ2 = 1.3, p = 0.33), but the difference was not significant. Two lice samples were found to harbour mixed DNA of B. quintana and A. baumannii. Phylogenetic analysis of the cytochrome b (cytb) gene sequences of the positive lice specimens placed them into clades A and E. This is the first report on the molecular identification of human lice and the detection of the DNA of pathogens of public health importance in lice in Nigeria, West Africa. The findings of this study will assist policy makers and medical practitioners in formulating a holistic healthcare delivery to IDPs.
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Affiliation(s)
- Joshua Kamani
- National Veterinary Research Institute (NVRI), Vom, Plateau State, Nigeria
| | - Yaarit Nachum-Biala
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Laminu Bukar
- National Veterinary Research Institute (NVRI), Vom, Plateau State, Nigeria
| | - Mike Shand
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Shimon Harrus
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Gin JL, Balut MD, Dobalian A. COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation. BMC PRIMARY CARE 2024; 25:24. [PMID: 38216894 PMCID: PMC10785369 DOI: 10.1186/s12875-023-02251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. METHODS This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). RESULTS Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. CONCLUSIONS These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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Anthonj C, Mingoti Poague KIH, Fleming L, Stanglow S. Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review. Int J Hyg Environ Health 2024; 255:114285. [PMID: 37925888 DOI: 10.1016/j.ijheh.2023.114285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - Lisa Fleming
- Independent Consultant, California, San Francisco, United States
| | - Sarah Stanglow
- Social Worker, Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Brown J, Acey CS, Anthonj C, Barrington DJ, Beal CD, Capone D, Cumming O, Pullen Fedinick K, MacDonald Gibson J, Hicks B, Kozubik M, Lakatosova N, Linden KG, Love NG, Mattos KJ, Murphy HM, Winkler IT. The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries. Lancet Glob Health 2023; 11:e606-e614. [PMID: 36925180 DOI: 10.1016/s2214-109x(23)00006-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 03/17/2023]
Abstract
Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.
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Affiliation(s)
- Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Charisma S Acey
- Department of City and Regional Planning, University of California, Berkeley, CA, USA
| | - Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, Netherlands
| | - Dani J Barrington
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Cara D Beal
- School of Pharmacy and Medical Sciences and Cities Research Institute, Griffith University, Southport, QLD, Australia
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristi Pullen Fedinick
- Natural Resources Defense Council, Washington, DC, USA; Center for Earth, Energy, and Democracy, Minneapolis, MN, USA
| | - Jacqueline MacDonald Gibson
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, USA
| | - Brittany Hicks
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Michal Kozubik
- Department of Social Work and Social Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia; Department of Community & Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - Karl G Linden
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Nancy G Love
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kaitlin J Mattos
- Department of Environment and Sustainability, Fort Lewis College, Durango, CO, USA
| | - Heather M Murphy
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Inga T Winkler
- Central European University, Department of Legal Studies, Vienna, Austria
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Drescher NR, Oladeru OT. Cancer Screening, Treatment, and Outcomes in Persons Experiencing Homelessness: Shifting the Lens to an Understudied Population. JCO Oncol Pract 2023; 19:103-105. [PMID: 36548925 DOI: 10.1200/op.22.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nicolette R Drescher
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Oluwadamilola T Oladeru
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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Faccini-Martínez ÁA, Kmetiuk LB, Blanton LS, Felipetto LG, Gravinatti ML, Timenetsky J, Gonçalves LR, Machado RZ, André MR, Figueiredo FB, Dos Santos AP, Labruna MB, Monti G, Biondo AW, Walker DH. Bartonella spp. and Typhus Group Rickettsiae among Persons Experiencing Homelessness, São Paulo, Brazil. Emerg Infect Dis 2023; 29:418-421. [PMID: 36692454 PMCID: PMC9881779 DOI: 10.3201/eid2902.221050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Persons experiencing homelessness in São Paulo, Brazil, were seropositive for Bartonella spp. (79/109, 72.5%) and typhus group rickettsiae (40/109, 36.7%). Bartonella quintana DNA was detected in 17.1% (14/82) body louse pools and 0.9% (1/114) blood samples. Clinicians should consider vectorborne agents as potential causes of febrile syndromes in this population.
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Zhu A, Bruketa E, Svoboda T, Patel J, Elmi N, El-Khechen Richandi G, Baral S, Orkin AM. Respiratory infectious disease outbreaks among people experiencing homelessness: a systematic review of prevention and mitigation strategies. Ann Epidemiol 2023; 77:127-135. [PMID: 35342013 DOI: 10.1016/j.annepidem.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE People experiencing homelessness (PEH) are at increased risk of respiratory infections and associated morbidity and mortality. To characterize optimal intervention strategies, we completed a systematic review of mitigation strategies for PEH to minimize the spread and impact of respiratory infectious disease outbreaks, including COVID-19. METHODS The study protocol was registered in PROSPERO (#2020 CRD42020208964) and was consistent with the preferred reporting in systematic reviews and meta-analyses guidelines. A search algorithm containing keywords that were synonymous to the terms "Homeless" and "Respiratory Illness" was applied to the six databases. The search concluded on September 22, 2020. Quality assessment was performed at the study level. Steps were conducted by two independent team members. RESULTS A total of 4468 unique titles were retrieved with 21 meeting criteria for inclusion. Interventions included testing, tracking, screening, infection prevention and control, isolation support, and education. Historically, there has been limited study of intervention strategies specifically for PEH across the world. CONCLUSIONS Staff and organizations providing services for people experiencing homelessness face specific challenges in adhering to public health guidelines such as physical distancing, isolation, and routine hygiene practices. There is a discrepancy between the burden of infectious diseases among PEH and specific research characterizing optimal intervention strategies to mitigate transmission in the context of shelters. Improving health for people experiencing homelessness necessitates investment in programs scaling existing interventions and research to study new approaches.
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Affiliation(s)
- Alice Zhu
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Department of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Eva Bruketa
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Queen's University, School of Medicine, Kingston, ON, Canada
| | - Tomislav Svoboda
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada
| | - Jamie Patel
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Ryerson University, Daphne Cockwell School of Nursing, Toronto, ON, Canada
| | - Nika Elmi
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Stefan Baral
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Aaron M Orkin
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, ON, Canada.
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12
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Allen EM, Smither B, Barranco L, Reynolds J, Bursey K, Mattson K, Mosites E. Communicating Effectively With People Experiencing Homelessness to Prevent Infectious Diseases. J Infect Dis 2022; 226:S340-S345. [PMID: 36208164 PMCID: PMC9619659 DOI: 10.1093/infdis/jiac336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background People experiencing homelessness (PEH) are disproportionately affected by many infectious diseases, including coronavirus disease 2019 (COVID-19). However, communication efforts during public health emergencies like the COVID-19 pandemic often do not consider the unique needs of PEH. We examined how PEH seek and receive health information and how traditional health communication methods resonate with them. Methods We conducted in-person focus groups with PEH in 4 jurisdictions (Cincinnati, Ohio; Denver, Colorado; Sacramento, California; and the Bronx, New York) during July 2021. Results Findings from 15 focus groups with PEH (n = 53) revealed the need for trusted messengers and consistent messaging across local organizations, as PEH seek to verify information they receive from multiple sources. PEH overwhelmingly preferred to receive health information through face-to-face conversations, especially with healthcare providers with whom they had an established relationship, but they also cited news media, the internet, and social media as their main sources for obtaining health information. PEH reported that effective communication products pair a recommended action with instructions and resources about how to take that action within their community. Conclusions These findings support healthcare providers collaborating with public health agencies to ensure that infectious disease prevention messages for PEH are provided by trusted messengers, multimodal, paired with resources, and consistent.
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Affiliation(s)
- Elizabeth M Allen
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Betsy Smither
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Lindsey Barranco
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reynolds
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kelli Bursey
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kristin Mattson
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Marshall KE, Martinez HE, Woodall T, Guerrero A, Mechtenberg J, Herlihy R, House J. Body Lice among People Experiencing Homelessness and Access to Hygiene Services during the COVID-19 Pandemic-Preventing Trench Fever in Denver, Colorado, 2020. Am J Trop Med Hyg 2022; 107:427-432. [PMID: 35895412 PMCID: PMC9393458 DOI: 10.4269/ajtmh.22-0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Eight people with human body louse-borne Bartonella quintana infections were detected among people experiencing homelessness (PEH) in Denver during January-September 2020, prompting a public health investigation and community outreach. Public health officials conducted in-person interviews with PEH to more fully quantify body lice prevalence, transmission risk factors, access to PEH resources, and how the COVID-19 pandemic has affected resource access. Recent body lice exposure was reported by 35% of 153 interview participants. In total, 75% of participants reported reduced access to PEH services, including essential hygiene activities to prevent body lice, during Colorado's COVID-19 stay-at-home orders. Future pandemic planning should consider hygiene resource allocation for PEH populations to prevent emerging and reemerging infections such as B. quintana.
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Affiliation(s)
- Kristen E. Marshall
- Colorado Department of Public Health and Environment, Denver, Colorado
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather E. Martinez
- Colorado Department of Public Health and Environment, Denver, Colorado
- Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | - Tracy Woodall
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Andrés Guerrero
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Jennifer House
- Colorado Department of Public Health and Environment, Denver, Colorado
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Boodman C, Wuerz T, Lagacé-Wiens P, Lindsay R, Dibernardo A, Bullard J, Stein DR, Keynan Y. Serologic testing for Bartonella in Manitoba, Canada, 2010-2020: a retrospective case series. CMAJ Open 2022; 10:E476-E482. [PMID: 35640989 PMCID: PMC9177198 DOI: 10.9778/cmajo.20210180] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bartonella are gram-negative bacilli not identified by routine bacterial culture. The objectives of this study were to review the results of all serologic testing for Bartonella ordered in Manitoba, Canada, and to review cases with positive test results among adults to assess species identification, risk factors, clinical manifestations and outcomes. METHODS This retrospective study included all Bartonella serologic tests ordered in Manitoba and performed at the National Microbiology Laboratory, Winnipeg, from Jan. 1, 2010, until Dec. 31, 2020. We analyzed the aggregate data for all serologic tests for Bartonella for patients of all ages. We reviewed the charts of adult (age ≥ 18 yr) patients with serologic positivity for Bartonella who had a medical chart at 1 of Winnipeg's 2 largest hospitals (Health Sciences Centre and St. Boniface Hospital) to extract clinical and demographic data and create a case series. Descriptive statistics were performed. RESULTS During the study period, 1014 Bartonella serologic tests were ordered in adult and pediatric patients, of which 24 (2.4%) gave a positive result. Sixteen adults (12 men and 4 women; mean age 48 yr) seen at a participating hospital had a positive result. Molecular species-level identification occurred on explanted cardiac valves in 5 (31%) of the 16 cases; B. quintana was identified in all 5. Six patients (38%) were diagnosed with probable B. quintana infection, for a total of 11 B. quintana cases (69%); 8 (73%) of the 11 had endocarditis. Four cases of B. quintana infection (36%) were associated with rural residence. Four cases (25%) of probable B. henselae were identified; 2 patients had fever and lymphadenopathy, and 2 had endocarditis. The remaining patient was deemed to have a false-positive result as his B. henselae titre was at the threshold for positivity, his B. quintana serologic test gave a negative result, and his clinical syndrome was not suggestive of Bartonella infection. Two patients died; both had multivalvular B. quintana endocarditis with ruptured intracranial mycotic aneurysms. INTERPRETATION Bartonella quintana was a common cause of Bartonella serologic positivity among adults in Manitoba in 2010-2020 and was associated with endocarditis and systemic embolization. As B. quintana is transmitted by body lice, active case finding for people who lack suitable housing, both in urban and rural settings, should prioritize those with elevated Bartonella titres to receive echocardiography and detect endocarditis before systemic embolization occurs.
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Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man.
| | - Terence Wuerz
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Philippe Lagacé-Wiens
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Robbin Lindsay
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Antonia Dibernardo
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Jared Bullard
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Derek R Stein
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man
| | - Yoav Keynan
- Section of Infectious Diseases (Boodman, Wuerz, Keynan), Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba; Departments of Medical Microbiology and Infectious Diseases (Boodman, Lagacé-Wiens, Bullard, Stein, Keynan) and Community Health Sciences (Wuerz), Max Rady College of Medicine, University of Manitoba; Shared Health (Lagacé-Wiens); National Microbiology Laboratory (Lindsay, Dibernardo); Cadham Provincial Laboratory (Bullard, Stein), Winnipeg, Man.
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15
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Balut MD, Gin JL, Alenkin NR, Dobalian A. Vaccinating Veterans Experiencing Homelessness for COVID-19: Healthcare and Housing Service Providers' Perspectives. J Community Health 2022; 47:727-736. [PMID: 35670986 PMCID: PMC9171468 DOI: 10.1007/s10900-022-01097-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 02/05/2023]
Abstract
This study examines challenges experienced during COVID-19 vaccination efforts, facilitating factors that increased vaccination, and lessons learned from healthcare providers and housing program staff who delivered healthcare and services to Veterans experiencing homelessness during the SARS-CoV-2 pandemic. Qualitative, semi-structured interviews were conducted with seven transitional housing program staff in northern California, southern California, Florida, Iowa, Kentucky, Massachusetts, and New Jersey (January-April 2021) and six primary care providers serving Veterans experiencing homelessness, four from clinics in California and two from a clinic in North Dakota (July-August 2021). Interviews were transcribed and analyzed using a rapid analysis approach. COVID-19 vaccination rates were between 40 and 60% among Veterans who received care from the primary care providers and between 20 and 90% among Veterans who were enrolled in the transitional housing programs. Barriers that providers and housing staff encountered when getting Veterans vaccinated for COVID-19 included lack of eligibility, the vaccine appointment scheduling process, transportation and communication challenges, Veterans' distrust in the government, vaccine mandates, and vaccine hesitancy among organization staff. Recommendations to increase COVID-19 vaccine uptake included making vaccination more convenient, using trusted sources such as homeless program staff or Veteran peers to provide educational information about the safety and efficacy of COVID-19 vaccines, and encouraging rather than mandating vaccination. These lessons will enable entities providing care to people experiencing homelessness to develop more effective policies and educational campaigns to improve vaccine acceptance and uptake among this vulnerable population.
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Affiliation(s)
- Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - Nikola R. Alenkin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA ,Division of Health Services Management and Policy, The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, 43210 Columbus, OH USA
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16
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Uzoka FME, Akwaowo C, Nwafor-Okoli C, Ekpin V, Nwokoro C, El Hussein M, Osuji J, Aladi F, Akinnuwesi B, Akpelishi TF. Risk factors for some tropical diseases in an African country. BMC Public Health 2021; 21:2261. [PMID: 34895220 PMCID: PMC8666074 DOI: 10.1186/s12889-021-12286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Often, non-clinical risk factors could affect the predisposition of an individual to diseases. Understanding these factors and their impacts helps in disease prevention and control. This study identified risk factors for malaria, yellow fever, typhoid, chickenpox, measles, hepatitis B, and urinary tract infection in a population in an African country. METHODS Our study was an observational, correlational, and quantitative one that explored relationships among risk variables and disease prevalence - without modifying or controlling the variables. Data for this study was obtained through random sampling of a population of patients and physicians in the eastern/southern, western, and northern parts of Nigeria in 2015-2016. A total of 2199 patient consultation forms were returned by 102 (out of 125) physicians, and considered useful for analysis. Demographic data of patients, physicians, and diagnosis outcomes were analysed descriptively through frequency distributions, aggregate analysis, and graphs. The influence of risk factors on the disease manifestations (diagnosis outcomes) was determined using regression analysis. RESULTS Our results show that living in a tropical climate is by far a major risk factor associated with tropical diseases (malaria: t = 19.9, typhoid: t = - 3.2, chickenpox: t = - 6.5 and typhoid: t = 12.7). The risk for contracting infections is relative to specific diseases; for example, contact with chickenpox infected person poses a high risk of contracting the virus (t = 41.8), while poor personal hygiene predisposes people to high risk of urinary tract infection (t = 23.6). On the other hand, urbanization and homelessness pose very low risks of disposing the individual to the diseases under consideration, while low fluid intake, lack of voiding, and wearing non-cotton underwear predispose individuals to few diseases. CONCLUSION The risk factors identified in our study exert differential and discriminating influences in the causation, predisposition, and transmission of these disease studied. It is recommended that significant effort be devoted by governments in the tropics to the mitigation of these modifiable risk factors. The most important strategy to mitigate the occurrence of these risk factors will be improving the living conditions of people and the provision of social protection measures to reduce the occurrence and burden of these diseases.
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Affiliation(s)
- F-M E Uzoka
- Dept. of Math and Computing, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, AB, T3E 6K6, Canada.
| | - C Akwaowo
- Dept. of Public Health, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - C Nwafor-Okoli
- Canadian Institute for Innovation and Development, Calgary, Canada
| | - V Ekpin
- Morat Medical Centre, Benin City, Nigeria
| | - C Nwokoro
- Dept of Computer Science, University of Uyo, Uyo, Nigeria
| | - M El Hussein
- School of Nursing, Mount Royal University, Calgary, Canada
| | - J Osuji
- School of Nursing, Mount Royal University, Calgary, Canada
| | - F Aladi
- Health Watch Medical Clinic, Calgary, Canada
| | - B Akinnuwesi
- Dept of Computer Science, University of Eswatini, Kwaluseni, Eswatini
| | - T F Akpelishi
- Health Centre, Bells University of Technology, Otta, Nigeria
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17
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Kuhn R, Henwood B, Lawton A, Kleva M, Murali K, King C, Gelberg L. COVID-19 vaccine access and attitudes among people experiencing homelessness from pilot mobile phone survey in Los Angeles, CA. PLoS One 2021; 16:e0255246. [PMID: 34329350 PMCID: PMC8323924 DOI: 10.1371/journal.pone.0255246] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/12/2021] [Indexed: 12/05/2022] Open
Abstract
People experiencing homelessness (PEH) are at high risk for COVID-19 complications and fatality, and have been prioritized for vaccination in many areas. Yet little is known about vaccine acceptance in this population. The objective of this study was to determine the level of vaccine hesitancy among PEH in Los Angeles, CA and to understand the covariates of hesitancy in relation to COVID-19 risk, threat perception, self-protection and information sources. A novel mobile survey platform was deployed to recruit PEH from a federally qualified health center (FQHC) in Los Angeles to participate in a monthly rapid response study of COVID-19 attitudes, behaviors, and risks. Of 90 PEH surveyed, 43 (48%) expressed some level of vaccine hesitancy based either on actual vaccine offers (17/90 = 19%) or a hypothetical offer (73/90 = 81%). In bivariate analysis, those with high COVID-19 threat perception were less likely to be vaccine hesitant (OR = 0.34, P = 0.03), while those who frequently practiced COVID-19 protective behaviors were more likely to be vaccine hesitant (OR = 2.21, P = 0.08). In a multivariate model, those with high threat perception (AOR = 0.25, P = 0.02) were less likely to be hesitant, while those engaging in COVID-19 protective behaviors were more hesitant (AOR = 3.63, P = 0.02). Those who trusted official sources were less hesitant (AOR = 0.37, P = 0.08) while those who trusted friends and family for COVID-19 information (AOR = 2.70, P = 0.07) were more likely to be hesitant. Findings suggest that targeted educational and social influence interventions are needed to address high levels of vaccine hesitancy among PEH.
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Affiliation(s)
- Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, United States of America
| | - Alexander Lawton
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Mary Kleva
- Akido Labs, Los Angeles, California, United States of America
| | - Karthik Murali
- Akido Labs, Los Angeles, California, United States of America
| | - Coley King
- Venice Family Clinic, Los Angeles, California, United States of America
| | - Lillian Gelberg
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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18
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Verbyla ME, Calderon JS, Flanigan S, Garcia M, Gersberg R, Kinoshita AM, Mladenov N, Pinongcos F, Welsh M. An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments. ENVIRONMENTAL ENGINEERING SCIENCE 2021; 38:389-401. [PMID: 34079210 PMCID: PMC8165467 DOI: 10.1089/ees.2020.0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/30/2020] [Indexed: 05/05/2023]
Abstract
Individuals experiencing unsheltered homelessness face significant barriers to accessing water, sanitation, and hygiene services, but the risks associated with this lack of access and barriers to service provision have been largely understudied. We analyzed water samples upstream and downstream of three homeless encampments in the San Diego River watershed and interviewed service providers from public and nonprofit sectors to assess local perceptions about challenges and potential solutions for water and sanitation service provision in this context. Water upstream from encampments contained detectable levels of caffeine and sucralose. Escherichia coli concentrations downstream of the encampments were significantly greater than concentrations upstream, but there was no significant change in the concentrations of other pollutants, including caffeine and sucralose. The HF183 marker of Bacteroides was only detected in one sample upstream of an encampment and was not detected downstream. Overall, there was insufficient evidence to suggest that the encampments studied here were responsible for contributing pollution to the river. Nevertheless, the presence of caffeine, sucralose, and HF183 indicated that there are anthropogenic sources of contamination in the river during dry weather and potential risks associated with the use of this water by encampment residents. Interviews with service providers revealed perceptions that the provision of water and sanitation services for this population would be prohibitively expensive. Interviewees also reported perceptions that most riverbank residents avoided contact with service providers, which may present challenges for the provision of water and sanitation service unless trust is first built between service providers and residents of riverine encampments.
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Affiliation(s)
- Matthew E. Verbyla
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
- Corresponding author: Department of Civil, Construction, and Environmental Engineering, MC-1324, San Diego State University, San Diego, CA 92182, USA. Phone: 619-594-0711; Fax: 619 594 8078;
| | - Jose S. Calderon
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Shawn Flanigan
- School of Public Affairs, San Diego State University, San Diego, California, USA
| | - Mireille Garcia
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Rick Gersberg
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Alicia M. Kinoshita
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Natalie Mladenov
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Federick Pinongcos
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Megan Welsh
- School of Public Affairs, San Diego State University, San Diego, California, USA
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Adly M, Woo TE, Traboulsi D, Klassen D, Hardin J. Understanding Dermatologic Concerns Among Persons Experiencing Homelessness: A Scoping Review and Discussion for Improved Delivery of Care. J Cutan Med Surg 2021; 25:616-626. [PMID: 33818163 PMCID: PMC8640276 DOI: 10.1177/12034754211004558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH). This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies. Search strategies developed for MEDLINE and hand searching yielded 486 articles. Out of the 486 articles screened, 93 articles met the inclusion criteria. The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe. Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 16.6% to 53.5%. Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus. There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population. PEH have a higher prevalence of skin infections and non-melanoma skin cancers. This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH. We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention.
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Affiliation(s)
- Merna Adly
- 704012129 University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Taylor Evart Woo
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
| | - Danya Traboulsi
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
| | - David Klassen
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - Jori Hardin
- Department of Dermatology, Cumming School of Medicine, Calgary, AB, Canada
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20
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A Survey on HIV, HCV, and HBV and Related Factors Among the Homeless Population, Southeast of Iran. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.108929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Homeless people are prone to sexually transmitted and blood-borne infectious diseases such as hepatitis B, hepatitis C, and HIV due to their risky behaviors and low awareness of various diseases. Objectives: Thus, the present research aimed to examine the epidemiologic patterns of HBV, HCV, HIV, and related factors among the homeless population of Zahedan in 2019. Methods: A cross-sectional study was conducted on a total of 329 homeless people. Eligible people were selected using a convenience sampling method from homeless individuals residing in care centers affiliated with the Welfare Organization and the Health Deputy of Zahedan University of Medical Sciences. Data on the demographic and behavioral characteristics of the cases were collected through a structured questionnaire completed in face-to-face interviews. A 10 cc blood sample was taken from each of the cases for serological tests of hepatitis B, hepatitis C, and HIV. The test results and collected data were entered in SPSS16 software. Logistic regression analysis and chi-square tests were used to analyze the data. Results: The majority of the cases (84%) were males, and 59% were in the age-group of 35 - 50 years. Of the subjects, 93% had a history of drug abuse, 74% reported a history of smoking, and 45% had tattoos. The prevalence of hepatitis C, hepatitis B, and HIV was 13%, 2.7%, and 0.3%, respectively (only one case of HIV was identified). In a multi-variate model, imprisonment history [OR = 2.32 (1.08 - 4.98)], history of sexual abuse [OR = 3.73 (1.36 - 10.26)], being widowed or divorced [OR = 2.83, (1.21 - 6.64)], and history of injection with shared needles and syringes [OR = 5.11 (1.97 - 13.28)] remained the predicting factors of hepatitis C. Conclusions: Based on the obtained results of the study, homeless people are more prone to infections with HCV, HBV, and HIV due to their risky behaviors. Therefore, a need is highlighted for preventive interventions and developing the level of health literacy in this group regarding behaviors contributing to the aforementioned infections.
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21
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Hoke MK, Boen CE. The health impacts of eviction: Evidence from the national longitudinal study of adolescent to adult health. Soc Sci Med 2021; 273:113742. [PMID: 33607393 PMCID: PMC8045672 DOI: 10.1016/j.socscimed.2021.113742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Eviction represents an urgent social and economic issue in the United States, with nearly two million evictions occurring annually in the U.S. Still, the population health impacts of evictions, as well as the pathways linking eviction to health, are not well documented or understood, particularly among young adults. Using nationally-representative, longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (1994-2008) (n = 9029), the present study uses a combination of analytic methods-including prospective lagged dependent variable regression models, inverse probabilities of treatment weighting, longitudinal first difference models, causal mediation techniques-to comprehensively assess whether and how evictions relate to depressive risk and self-rated health across early adulthood, paying particular attention to the stress-related pathways linking eviction and health. Results provide robust evidence of positive longitudinal associations between eviction and depressive risk, in particular. In the prospective regression models, young adults who experienced recent eviction had more depressive symptoms and worse self-rated health than those who were not evicted, net a host of background characteristics. Using treatment weighting techniques, results showed that young adults who experienced eviction had more depressive symptoms than those who were not evicted (5.921 vs. 4.998 depressive symptoms, p = 0.003). Perceived social stress mediated nearly 18 percent of the associations between eviction and the depressive symptoms (p < 0.001). In the first difference models, young people who experienced eviction between survey waves experienced greater increases in depressive symptoms over time compared to those who were not evicted, net of changes in other indicators of socioeconomic status and residential instability. Taken together, our results suggest that the recent surges in evictions in the U.S. serve as a potent threat to population health during the emerging adult period, with especially devastating consequences for low-income individuals and communities of color.
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Affiliation(s)
- Morgan K Hoke
- Population Studies Center, University of Pennsylvania, USA; Department of Anthropology, University of Pennsylvania, USA.
| | - Courtney E Boen
- Population Studies Center, University of Pennsylvania, USA; Department of Sociology, Population Aging Research Center, University of Pennsylvania, USA
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22
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Kahlig P, Paris DH, Neumayr A. Louse-borne relapsing fever-A systematic review and analysis of the literature: Part 1-Epidemiology and diagnostic aspects. PLoS Negl Trop Dis 2021; 15:e0008564. [PMID: 33705384 PMCID: PMC7951878 DOI: 10.1371/journal.pntd.0008564] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Louse-borne relapsing fever (LBRF) is a classical epidemic disease, which in the past was associated with war, famine, poverty, forced migration, and crowding under poor hygienic conditions around the world. The disease's causative pathogen, the spirochete bacterium Borrelia recurrentis, is confined to humans and transmitted by a single vector, the human body louse Pediculus humanus. Since the disease has had its heyday before the days of modern medicine, many of its aspects have never been formally studied and to date, remain incompletely understood. In order to shed light on some of these aspects, we have systematically reviewed the accessible literature on LBRF, since the recognition of its mode of transmission in 1907, and summarized the existing data on epidemiology and diagnostic aspects of the disease. Publications were identified by using a predefined search strategy on electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of LBRF published in English, French, German, and Spanish since 1907 were included. Data extraction followed a predefined protocol and included a grading system to judge the certainty of the diagnosis of reported cases. Historically, Ethiopia is considered a stronghold of LBRF. The recognition of LBRF among East African migrants (originating from Somalia, Eritrea, and Ethiopia) arriving to Europe in the course of the recent migration flow from this region suggests that this epidemiological focus ostensibly persists. Currently, there is neither evidence to support or refute active transmission foci of LBRF elsewhere on the African continent, in Latin America, or in Asia. Microscopy remains the most commonly used method to diagnose LBRF. Data are lacking on sensitivity and specificity of most diagnostic methods.
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Affiliation(s)
- Pascal Kahlig
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H. Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
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Ly TDA, Castaneda S, Hoang VT, Dao TL, Gautret P. Vaccine-preventable diseases other than tuberculosis, and homelessness: A scoping review of the published literature, 1980 to 2020. Vaccine 2021; 39:1205-1224. [PMID: 33509694 DOI: 10.1016/j.vaccine.2021.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Homelessness may result in the breakdown of regular health services, including routine vaccination programmes. A scoping review was conducted to describe vaccine-preventable diseases (VPD) other than tuberculosis in people experiencing homelessness (PEH). METHODS We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched peer-reviewed literature published in English, French, Spanish or Portuguese reporting the outbreak of VPD or VPD prevalence in both infant and adult homeless populations published between 1980 and 2020, using PubMed/Medline, SciELO, Google Scholar, and Web of Science databases. Relevant information from the studies was charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Eighty-one articles were included. A high prevalence of past hepatitis B virus (HBV) and hepatitis A virus (HAV) infections were observed through serosurveys, mostly in high income countries or high-middle income countries (USA, Canada, France, Iran or Brazil). Ten outbreaks of HAV infection were also reported, with lethality rates ranging from 0 to 4.8%. The studies identified numerous risk factors positively associated with HBV infection, including older age, homosexual or bisexual practice, injected drug use (IDU), and, with HAV infection including IDU, having sexual partner(s) with a history of unspecified hepatitis, insertive anal penetration, or originating from a country with a high prevalence of anti-HAV antibody. Eleven outbreaks of pneumococcal infection affecting PEH were reported in Canada and USA, with lethality rates from 0 to 15.6%. Six diphtheria outbreaks were reported. Vaccination status was rarely documented in these studies. CONCLUSIONS The literature suggests that homeless populations generally experience a high VPD burden suggesting the need for a national vaccination programme and planning for delivering vaccines in this population.
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Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | | | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Pneumology Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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24
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Baral S, Bond A, Boozary A, Bruketa E, Elmi N, Freiheit D, Ghosh SM, Goyer ME, Orkin AM, Patel J, Richter T, Robertson A, Sutherland C, Svoboda T, Turnbull J, Wong A, Zhu A. Seeking shelter: homelessness and COVID-19. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
| | - Andrew Bond
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Andrew Boozary
- Population Health and Social Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
- University of Toronto, Toronto, ON M5S 1A8, Canada
- Columbia University, New York, NY 10032, USA
| | - Eva Bruketa
- Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Nika Elmi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S. Monty Ghosh
- Department of General Internal Medicine & Neurology, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Department of Medicine & Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie Eve Goyer
- Family Medicine and Emergency Department, University of Montréal, Montréal, QC H3T 1J4, Canada
| | - Aaron M. Orkin
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Emergency Medicine, St. Joseph’s Health Centre, Toronto, ON M6R 1B5, Canada
- Department of Emergency Medicine, Humber River Hospital, Toronto, ON M3M 0B2, Canada
| | - Jamie Patel
- Faculty of Community Services, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Tim Richter
- Canadian Alliance to End Homelessness, Calgary, AB T3H 0N8, Canada
| | - Angela Robertson
- Parkdale Queen West Community Health Centre, Toronto, ON M6K 1L2, Canada
| | - Christy Sutherland
- PHS Community Services Society, Vancouver, BC V6A 1M9, Canada
- Department of Family Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tomislav Svoboda
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Jeffrey Turnbull
- University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Ottawa Inner City Health, Ottawa, ON K1N 5N7, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, SK S4T 0H8, Canada
| | - Alice Zhu
- University of Toronto, Toronto, ON M5S 1A8, Canada
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25
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Yoon JC, Montgomery MP, Buff AM, Boyd AT, Jamison C, Hernandez A, Schmit K, Shah S, Ajoku S, Holland DP, Prieto J, Smith S, Swancutt MA, Turner K, Andrews T, Flowers K, Wells A, Marchman C, Laney E, Bixler D, Cavanaugh S, Flowers N, Gaffga N, Ko JY, Paulin HN, Weng MK, Mosites E, Morris SB. COVID-19 Prevalence among People Experiencing Homelessness and Homelessness Service Staff during Early Community Transmission in Atlanta, Georgia, April-May 2020. Clin Infect Dis 2020; 73:e2978-e2984. [PMID: 32898272 PMCID: PMC7499502 DOI: 10.1093/cid/ciaa1340] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
Background In response to reported COVID-19 outbreaks among people experiencing homelessness (PEH) in other U.S. cities, we conducted multiple, proactive, facility-wide testing events for PEH living sheltered and unsheltered and homelessness service staff in Atlanta, Georgia. We describe SARS-CoV-2 prevalence and associated symptoms and review shelter infection prevention and control (IPC) policies Methods PEH and staff were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) during April 7–May 6, 2020. A subset of PEH and staff was screened for symptoms. Shelter assessments were conducted concurrently at a convenience sample of shelters using a standardized questionnaire Results Overall, 2,875 individuals at 24 shelters and nine unsheltered outreach events underwent SARS-CoV-2 testing and 2,860 (99.5%) had conclusive test results. SARS-CoV-2 prevalence was 2.1% (36/1,684) among PEH living sheltered, 0.5% (3/628) among PEH living unsheltered, and 1.3% (7/548) among staff. Reporting fever, cough, or shortness of breath in the last week during symptom screening was 14% sensitive and 89% specific for identifying COVID-19 cases compared with RT-PCR. Prevalence by shelter ranged 0%–27.6%. Repeat testing 3–4 weeks later at four shelters documented decreased SARS-CoV-2 prevalence (0%–3.9%). Nine of 24 shelters completed shelter assessments and implemented IPC measures as part of the COVID-19 response Conclusions PEH living in shelters experienced higher SARS-CoV-2 prevalence compared with PEH living unsheltered. Facility-wide testing in congregate settings allowed for identification and isolation of COVID-19 cases and is an important strategy to interrupt SARS-CoV-2 transmission
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Affiliation(s)
- Jane C Yoon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Martha P Montgomery
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann M Buff
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew T Boyd
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Calla Jamison
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfonso Hernandez
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristine Schmit
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarita Shah
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - David P Holland
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Fulton County Board of Health, Atlanta, GA, USA
| | | | - Sasha Smith
- Fulton County Board of Health, Atlanta, GA, USA
| | | | - Kim Turner
- Fulton County Board of Health, Atlanta, GA, USA
| | | | | | | | | | - Emaline Laney
- Emory University School of Medicine, Atlanta, GA, USA
| | - Danae Bixler
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Cavanaugh
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Flowers
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas Gaffga
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Y Ko
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather N Paulin
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark K Weng
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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26
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Figgatt M, Hildick-Smith J, Addish E, Coleman J, Benitez J, Freeland C, Alles S, Viner K, Johnson C, Kuncio D. Susceptibility to Hepatitis A and B Virus Among Clients at a Syringe Services Program in Philadelphia, 2018. Public Health Rep 2020; 135:691-699. [PMID: 32791034 DOI: 10.1177/0033354920943528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Although many people who use drugs meet criteria for vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV), estimates of susceptibility (ie, lack of immunity) are not well established. This study sought to identify the prevalence of and characteristics associated with HAV and HBV susceptibility among people who use drugs attending an urban syringe services program. METHODS We initiated this seroprevalence study in 2018 among 438 clients of a syringe services program who met study criteria, including provision of a blood specimen and a self-reported history of drug use. We assessed HAV and HBV susceptibility and infection via serological testing. We examined associations between participant characteristics and serology status by using descriptive statistics and multivariable logistic regression models. RESULTS Of the initial 438 clients identified, 353 (80.6%) met study criteria. Of 352 participants with conclusive HAV test results, 48.6% (n = 171) were HAV susceptible; of 337 participants with conclusive HBV test results, 32.6% (n = 110) were HBV susceptible, 24.3% (n = 82) showed evidence of past or present HBV infection, and 43.0% (n = 145) had vaccine-derived immunity. Compared with participants born before 1970, participants born during 1980-1989 had 5.90 (95% CI, 2.42-14.40) times the odds of HAV susceptibility and 0.18 (95% CI, 0.06-0.53) times the odds of HBV susceptibility, and participants born during 1990-1999 had 6.31 (95% CI, 2.34-17.00) times the odds of HAV susceptibility. Decreased odds of HAV susceptibility were associated with homelessness (adjusted odds ratio = 0.48; 95% CI, 0.28-0.82). CONCLUSION Despite applicable HAV and HBV vaccination recommendations, substantial gaps exist in HAV and HBV susceptibility among a population of people who use drugs. These findings highlight the need for increased HAV and HBV vaccination efforts among people who use drugs.
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Affiliation(s)
- Mary Figgatt
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | | | - Eman Addish
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | | | - José Benitez
- Prevention Point Philadelphia, Philadelphia, PA, USA
| | | | - Steven Alles
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kendra Viner
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Caroline Johnson
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Danica Kuncio
- 6542 Philadelphia Department of Public Health, Philadelphia, PA, USA
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27
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Schrooyen L, Delforge M, Lebout F, Vanbaelen T, Lecompte A, Dauby N. Homeless people hospitalized with COVID-19 in Brussels. Clin Microbiol Infect 2020; 27:151-152. [PMID: 32777362 PMCID: PMC7411419 DOI: 10.1016/j.cmi.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Loïc Schrooyen
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium.
| | - Marc Delforge
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Faustine Lebout
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Thibaut Vanbaelen
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Amaryl Lecompte
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Belgium; Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium
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28
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van Dulm E, Klok S, Boyd A, Joore IK, Prins M, van Dam AP, Tramper-Stranders GA, van Duijnhoven YTHP. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among undocumented migrants and uninsured legal residents in Amsterdam, the Netherlands: a cross-sectional study. Antimicrob Resist Infect Control 2020; 9:118. [PMID: 32727560 PMCID: PMC7391596 DOI: 10.1186/s13756-020-00785-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased risk of infection. Colonization with MRSA is observed in < 1% of the general Dutch population. Increased risk for MRSA carriage is known to occur in several key groups, one of which is asylum seekers. However, little is known about MRSA carriage among undocumented migrants and uninsured legal residents. This study aimed to determine the prevalence of nasal MRSA carriage among these groups in Amsterdam, the Netherlands. METHODS In this cross-sectional study, between October 2018 and October 2019, undocumented migrants and uninsured legal residents aged 18 years or older who were able to understand one of the study languages were recruited at an NGO health care facility in Amsterdam, the Netherlands, for general practitioner (GP) consultations. Participants were asked questions on demographics, migration history, antibiotic use and other possible risk factors for MRSA carriage and were screened for nasal MRSA carriage by selective culturing e-swabs. Characteristics of MRSA-negative and MRSA-positive participants were compared using univariable logistic regression analysis with Firth's correction. RESULTS Of the 3822 eligible patients, 760 were screened for nasal MRSA carriage (19.9%). Of the 760 participants, over half were male (58%; 442/760) and originated mainly from Africa (35%; 267/760), Asia (30%; 229/760) and North or South America (30%; 227/760). In total, 705/760 participants (93%) were undocumented migrants and 55/760 (7%) were uninsured legal residents of Amsterdam. The overall prevalence of nasal MRSA carriage was 2.0% (15/760) (95%CI 1.1 to 3.2%), with no difference between undocumented migrants (14/705) (2.0, 95%CI 1.1 to 3.3%) and uninsured legal residents (1/55) (1.8, 95%CI 0.1 to 9.7%). Genotyping showed no clustering of the 15 isolates. MRSA carriage was not associated with sociodemographic, migration history or other possible risk factors. Nevertheless, this study had limited power to detect significant determinants. Three participants (3/15; 20%) harbored Panton-Valentine leukocidin (PVL)-positive isolates. CONCLUSION Even though our study population of undocumented migrants and uninsured legal residents had a higher prevalence of nasal MRSA carriage compared to the general Dutch population, the prevalence was relatively low compared to acknowledged other high-risk groups.
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Affiliation(s)
- E van Dulm
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.
| | - S Klok
- NGO health care clinic Kruispost, Amsterdam, the Netherlands
| | - A Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - I K Joore
- Department of Infectious Diseases, Public Health Service Flevoland, Lelystad, the Netherlands
| | - M Prins
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Amsterdam, the Netherlands
| | - A P van Dam
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Y T H P van Duijnhoven
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands
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29
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Ly TDA, Dao TL, Hoang VT, Braunstein D, Brouqui P, Lagier JC, Parola P, Gautret P. Pattern of infections in French and migrant homeless hospitalised at Marseille infectious disease units, France: A retrospective study, 2017-2018. Travel Med Infect Dis 2020; 36:101768. [PMID: 32504668 DOI: 10.1016/j.tmaid.2020.101768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND No research has been conducted on the clinical characteristics and outcomes of homeless patients (HP) hospitalized in Infectious Disease Units (IDU). METHODS We conducted a retrospective survey among 98 HP and 98 non-HP admitted between 2017 and 2018 in several IDUs in Marseille, France. RESULTS HP were more likely to be migrant, to report frequent alcohol consumption or illicit drug use, and to present with respiratory symptoms at admission compared to controls. The most common final diagnoses in HP were respiratory tract infections (other than pulmonary tuberculosis [PTB], 35.7%), sexually transmitted infections (20.4%), cutaneous and mucosal infections (19.4%) and tuberculosis (12.2%). Sexually transmitted infections and ectoparasite infestations were significantly more frequent in HP compared to controls. One HP died from pleural effusion as a complication of PTB. The surviving HP had a longer length of stay (LOS, average 11.6 ± 13.6 days, p < 0.0001) than controls; independent factors of increased LOS were tobacco use (p = 0.009), tuberculosis infection (p < 0.0001), urinary tract infection (p = 0.018) and bacteraemia (p = 0.018). After hospital discharge, attendance at subsequent planned consultations was significantly lower in HP (0.72 ± 1.25 times/persons) compared to controls (2.03 ± 2.2). CONCLUSIONS We suggest that HP present specific demographic characteristics and patterns of infectious diseases compared to other patients and therefore require adapted management.
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Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Pneumology Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - David Braunstein
- Department of Medical Information, APHM, Marseille, France; Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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30
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Amanzougaghene N, Mediannikov O, Ly TDA, Gautret P, Davoust B, Fenollar F, Izri A. Molecular investigation and genetic diversity of Pediculus and Pthirus lice in France. Parasit Vectors 2020; 13:177. [PMID: 32264930 PMCID: PMC7140345 DOI: 10.1186/s13071-020-04036-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Humans are parasitized by three types of lice: body, head and pubic lice. As their common names imply, each type colonizes a specific region of the body. The body louse is the only recognized disease vector. However, an increasing awareness of head lice as a vector has emerged recently whereas the status of pubic lice as a vector is not known since it has received little attention. METHODS Here, we assessed the occurrence of bacterial pathogens in 107 body lice, 33 head lice and 63 pubic lice from Marseille and Bobigny (France) using molecular methods. RESULTS Results show that all body lice samples belonged to the cytb Clade A whereas head lice samples belonged to Clades A and B. DNA of Bartonella quintana was detected in 7.5% of body lice samples and, for the first time to our knowledge, in 3.1% of pubic lice samples. Coxiella burnetii, which is not usually associated with transmission by louse, was detected in 3.7% of body lice samples and 3% of head lice samples. To the best of our knowledge, this is the first report of C. burnetii in Pediculus lice infesting humans in France. Acinetobacter DNA was detected in 21.5% of body lice samples, 6% of head lice samples and 9.5% of pubic lice samples. Five species were identified with A. baumannii being the most prevalent. CONCLUSIONS Our study is the first to report the presence of B. quintana in pubic lice. This is also the first report of the presence of DNA of C. burnetii in body lice and head lice in France. Further efforts on the vectorial role of human lice are needed, most importantly the role of pubic lice as a disease vector should be further investigated.
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Affiliation(s)
- Nadia Amanzougaghene
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France. .,IHU-Méditerranée Infection, Marseille, France.
| | - Oleg Mediannikov
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France. .,IHU-Méditerranée Infection, Marseille, France.
| | - Tran Duc Anh Ly
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Bernard Davoust
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Florence Fenollar
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Arezki Izri
- Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne, Bobigny, France.,UMR "Émergence des Pathologies Virales" (EPV, Aix-Marseille University-IRD, 190-Inserm 1207 EHESP-IHU Méditerranée Infection), Marseille, France
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31
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Lam JC, Fonseca K, Pabbaraju K, Meatherall BL. Case Report: Bartonella quintana Endocarditis Outside of the Europe-African Gradient: Comprehensive Review of Cases within North America. Am J Trop Med Hyg 2020; 100:1125-1129. [PMID: 30793686 DOI: 10.4269/ajtmh.18-0929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Clinical syndromes associated with Bartonella quintana infection can be insidious and difficult to diagnose for multiple reasons. Clinically, B. quintana can manifest as asymptomatic bacteremia or with subtle subacute constitutional symptoms. Second, it is a fastidious organism that is difficult to identify using traditional culture methods. Last, the body lice vector of B. quintana transmission is likely not uncommon in most patients affected, who are homeless and of low socioeconomic status. Therefore, barriers in seeking medical care and financial constraints for medications are important considerations. The mainstay of literature surrounding B. quintana endocarditis is from Europe and the developing nations. Herein, we describe a case of native valve endocarditis secondary to B. quintana in a homeless male with preexisting valvular disease and undertake a comprehensive literature review of documented B. quintana endocarditis in North America.
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Affiliation(s)
- John C Lam
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kevin Fonseca
- Provincial Laboratory for Public Health, Calgary, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Canada
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Cleland CM, Bennett AS, Elliott L, Rosenblum A, Britton PC, Wolfson-Stofko B. Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference. Drug Alcohol Depend 2020; 206:107734. [PMID: 31775106 PMCID: PMC6980716 DOI: 10.1016/j.drugalcdep.2019.107734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To better understand overdose (OD) risk and develop tailored overdose risk interventions, we surveyed 234 opioid-using veterans residing in New York City, 2014-2017. Our aim was to better understand how predictors of OD may be associated with physical and mental health challenges, including pain severity and interference, depression and suicidal ideation over time. METHODS Veterans completed monthly assessments of the Overdose Risk Behavior Scale (ORBS), pain severity and interference, suicidal ideation, and depression for up to two years and were assessed an average of 14 times over 611 days. To estimate between-person and within-person associations between time-varying covariates and opioid risk behavior, mixed-effects regression was used on the 145-person subsample of veterans completing the baseline and at least three follow-up assessments. RESULTS The level of each time-varying covariate at the average of study time (between-person effect) was positively related to ORBS for pain severity and interference, suicidal ideation, and depression. Deviations from individuals' personal trajectories (within-person effect) were positively related to ORBS for pain severity and interference, suicidal ideation, and depression. CONCLUSIONS US military veterans endure physical and mental health challenges elevating risk for opioid-related overdose. When pain severity, pain interference, suicidal ideation and depression were higher than usual, opioid risk behavior was higher. Conversely, when these health issues were less of a problem than usual, opioid risk behavior was lower. Assessing the physical and mental health of opioid-using veterans over time may support the development and implementation of interventions to reduce behaviors that increase the likelihood of overdose.
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Affiliation(s)
- Charles M. Cleland
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012,Department of Population Health, New York University School
of Medicine, 180 Madison Avenue, New York, NY, 10016
| | - Alex S. Bennett
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Luther Elliott
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Andrew Rosenblum
- National Development and Research Institutes/USA, New York,
NY, 10010
| | - Peter C. Britton
- VA Center of Excellence for Suicide Prevention, Canandaigua
VA Medical Center, 400 Fort Hill Avenue Canandaigua, NY, USA 14424,Department of Psychiatry, University of Rochester, USA
Rochester, NY
| | - Brett Wolfson-Stofko
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
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Kaplan-Weisman L, Waltermaurer E, Crump C. Assessing and Improving Zoster Vaccine Uptake in a Homeless Population. J Community Health 2019; 43:1019-1027. [PMID: 29730833 DOI: 10.1007/s10900-018-0517-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The herpes zoster (shingles) vaccine is recommended for all adults aged ≥ 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults. To address these barriers, we developed a new approach of partnering our on-site primary care clinic in a transitional homeless shelter with a local pharmacy and offering vaccination on Shingles Immunization Days with a goal of matching or exceeding the national zoster immunization rate of 30.6%. Over a 3-year period, the live attenuated zoster vaccine was offered to 86% of eligible patients resulting in an immunization rate of 38.1%. This is higher than the estimated national rate but significantly lower than rates of tetanus (80.6%), pneumococcal (76.3%), and influenza (69.6%) vaccination in the same population, highlighting the unique obstacles to zoster immunization. Major reasons that patients were not immunized included lack of insurance coverage and patient refusal of all vaccines. Our findings demonstrate that homeless adults are interested in zoster vaccination and a model of on-site primary care in a shelter partnering with a pharmacy can successfully improve vaccine uptake in this population. Coverage of the new inactivated zoster vaccine under Medicare Part B could increase the national zoster immunization rate.
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Affiliation(s)
- Laura Kaplan-Weisman
- Institute for Family Health, New York, NY, USA.
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA.
- Care for the Homeless, New York, NY, USA.
| | - Eve Waltermaurer
- Institute for Family Health, New York, NY, USA
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA
| | - Casey Crump
- Institute for Family Health, New York, NY, USA
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Taylor JEB, Surey J, MacLellan J, Francis M, Abubakar I, Stagg HR. Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study. BMC Infect Dis 2019; 19:372. [PMID: 31046683 PMCID: PMC6498651 DOI: 10.1186/s12879-019-3926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359, Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josephine E B Taylor
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Julian Surey
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Jennifer MacLellan
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Marie Francis
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.
| | - Helen R Stagg
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
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Moffa M, Cronk R, Fejfar D, Dancausse S, Padilla LA, Bartram J. A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. Int J Hyg Environ Health 2019; 222:335-346. [DOI: 10.1016/j.ijheh.2018.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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Holowatyj AN, Heath EI, Pappas LM, Ruterbusch JJ, Gorski DH, Triest JA, Park HK, Beebe-Dimmer JL, Schwartz AG, Cote ML, Schwartz KL. The Epidemiology of Cancer Among Homeless Adults in Metropolitan Detroit. JNCI Cancer Spectr 2019; 3:pkz006. [PMID: 30944890 PMCID: PMC6433093 DOI: 10.1093/jncics/pkz006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/01/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Homeless individuals suffer and die disproportionately from chronic diseases and disorders. We describe the epidemiology of cancer among homeless persons in metropolitan Detroit. METHODS A retrospective cohort study was performed using 1973-2014 data from the Metropolitan Detroit Cancer Surveillance System, a population-based cancer registry and member of the National Institutes of Health-National Cancer Institute's Surveillance, Epidemiology, and End Results program. Homeless adults were identified through address at diagnosis listed as a homeless shelter, hospital, or supplemental field indicating homelessness. Age-adjusted, sex-specific proportional incidence ratios (PIR) compared cancer incidence proportions by primary tumor site of homeless patients to the nonhomeless referent population. Kaplan-Meier curves depicted unadjusted survival differences in a propensity score matched sample. Differences in 10-year survival were assessed using the score test with a sandwich estimator accounting for matched cluster effects. Statistical tests were two-sided. RESULTS A total of 388 individuals experienced homelessness at first primary invasive cancer diagnosis. Statistically significantly higher proportions of respiratory system (PIR = 1.51; 95% confidence interval = 1.28 to 1.79) and female genital system (PIR = 1.83; 95% confidence interval = 1.31 to 2.55) cancers were observed among homeless men and women, respectively. Homeless persons had poorer overall and cancer-reported survival compared with a propensity score matched referent population (median: overall survival, 20.0 vs 38.0 months, respectively, P < .001; cancer-reported survival, 38.0 vs 64.0 months, respectively, P < .001). CONCLUSION Disparities in disease burden exist between adults who are experiencing homelessness compared with the nonhomeless population at cancer diagnosis. These findings provide clinically relevant information to understand the cancer burden in this medically underserved population and suggest an urgent need to develop cancer prevention and intervention programs to reduce disparities and improve the health of homeless persons.
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Affiliation(s)
- Andreana N Holowatyj
- Correspondence to: Andreana N. Holowatyj, PhD, MS, Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4746, Salt Lake City, UT 84112 (e-mail: )
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Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:153-156. [PMID: 30763295 PMCID: PMC6375653 DOI: 10.15585/mmwr.mm6806a6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatitis A (HepA) vaccination is recommended routinely for children at age 12-23 months, for persons who are at increased risk for hepatitis A virus (HAV) infection, and for any person wishing to obtain immunity. Persons at increased risk for HAV infection include international travelers to areas with high or intermediate hepatitis A endemicity, men who have sex with men, users of injection and noninjection drugs, persons with chronic liver disease, person with clotting factor disorders, persons who work with HAV-infected primates or with HAV in a research laboratory setting, and persons who anticipate close contact with an international adoptee from a country of high or interme-diate endemicity (1-3). Persons experiencing homelessness are also at higher risk for HAV infection and severe infection-associated outcomes. On October 24, 2018, the Advisory Committee on Immunization Practices (ACIP)* recommended that all persons aged 1 year and older experiencing homelessness be routinely immunized against HAV. The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine to persons experiencing homelessness, which included a set of criteria assessing the benefits and adverse events associated with vaccination. HepA vaccines are highly immunogenic, and >95% of immunocompetent adults develop protective antibody within 4 weeks of receipt of 1 dose of the vaccine (1). HAV infections are acquired primarily by the fecal-oral route by either person-to-person transmission or via ingestion of contaminated food or water. Among persons experiencing homelessness, effective implementation of alternative strategies to prevent exposure to HAV, such as strict hand hygiene, is difficult because of living conditions among persons in this population. Integrating routine HepA vaccination into health care services for persons experiencing homelessness can reduce the size of the at-risk population over time and thereby reduce the risk for large-scale outbreaks.
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Faccini-Martínez ÁA, Márquez AC, Bravo-Estupiñan DM, Calixto OJ, López-Castillo CA, Botero-García CA, Hidalgo M, Cuervo C. Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia. Emerg Infect Dis 2018; 23:1876-1879. [PMID: 29048284 PMCID: PMC5652414 DOI: 10.3201/eid2311.170341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In 2015, we investigated Bartonella quintana and typhus group rickettsiae in body lice from homeless persons in Bogotá, Colombia. We found B. quintana–infected body lice and seroprevalence of this microorganism in 19% of homeless persons and typhus group rickettsiae in 56%. Public health professionals should start preemptive measures and active vector control.
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Ly TDA, Edouard S, Badiaga S, Tissot-Dupont H, Hoang VT, Pommier de Santi V, Brouqui P, Raoult D, Gautret P. Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015-2017: cross sectional 1-day surveys. Clin Microbiol Infect 2018; 25:249.e1-249.e6. [PMID: 29777925 PMCID: PMC7128312 DOI: 10.1016/j.cmi.2018.04.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Abstract
Objectives To assess risk factors for respiratory tract infection symptoms and signs in sheltered homeless people in Marseille during the winter season, including pathogen carriage. Methods Data on 479 male participants within two shelters who completed questionnaires and a total of 950 nasal and pharyngeal samples were collected during the winters of 2015–2017. Respiratory pathogen carriage including seven viruses and four bacteria was assessed by quantitative PCR. Results The homeless population was characterized by a majority of individuals of North African origin (300/479, 62.6%) with a relatively high prevalence of chronic homelessness (175/465, 37.6%). We found a high prevalence of respiratory symptoms and signs (168/476, 35.3%), a very high prevalence of bacterial carriage (313/477, 65.6%), especially Haemophilus influenzae (280/477, 58.7%), and a lower prevalence of virus carriage (51/473, 10.8%) with human rhinovirus being the most frequent (25/473, 5.3%). Differences were observed between the microbial communities of the nose and throat. Duration of homelessness (odds ratio (OR) 1.77, p 0.017), chronic respiratory diseases (OR 5.27, p <0.0001) and visiting countries of origin for migrants (OR 1.68, p 0.035) were identified as independent risk factors for respiratory symptoms and signs. A strong association between virus (OR 2.40, p 0.012) or Streptococcus pneumoniae (OR 2.32, p 0.014) carriage and respiratory symptoms and signs was also found. Conclusions These findings allowed identification of the individuals at higher risk for contracting respiratory tract infections to better target preventive measures aimed at limiting the transmission of these diseases in this setting.
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Affiliation(s)
- T D A Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - S Edouard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - S Badiaga
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - H Tissot-Dupont
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - V T Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - V Pommier de Santi
- French Military Centre for Epidemiology and Public Health Marseille, France
| | - P Brouqui
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - D Raoult
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - P Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.
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Louni M, Mana N, Bitam I, Dahmani M, Parola P, Fenollar F, Raoult D, Mediannikov O. Body lice of homeless people reveal the presence of several emerging bacterial pathogens in northern Algeria. PLoS Negl Trop Dis 2018; 12:e0006397. [PMID: 29664950 PMCID: PMC5922582 DOI: 10.1371/journal.pntd.0006397] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/27/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human lice, Pediculus humanus, are obligate blood-sucking parasites. Body lice, Pediculus h. humanus, occur in two divergent mitochondrial clades (A and D) each exhibiting a particular geographic distribution. Currently, the body louse is recognized as the only vector for louse-borne diseases. In this study, we aimed to study the genetic diversity of body lice collected from homeless populations in three localities of northern Algeria, and to investigate louse-borne pathogens in these lice. METHODOLOGY/PRINCIPAL FINDINGS In this study, 524 body lice specimens were collected from 44 homeless people in three localities: Algiers, Tizi Ouzou and Boumerdès located in northern Algeria. Duplex clade specific real-time PCRs (qPCR) and Cytochrome b (cytb) mitochondrial DNA (mtDNA) analysis were performed in order to identify the mitochondrial clade. Screening of louse-borne pathogens bacteria was based on targeting specific genes for each pathogen using qPCR supplemented by sequencing. All body lice belong to clade A. Through amplification and sequencing of the cytb gene we confirmed the presence of three haplotypes: A5, A9 and A63, which is novel. The molecular investigation of the 524 body lice samples revealed the presence of four human pathogens: Bartonella quintana (13.35%), Coxiella burnetii (10.52%), Anaplasma phagocytophilum (0.76%) and Acinetobacter species (A. baumannii, A. johnsonii, A. berezeniae, A. nosocomialis and A. variabilis, in total 46.94%). CONCLUSIONS/SIGNIFICANCE To the best of our knowledge, our study is the first to show the genetic diversity and presence of several emerging pathogenic bacteria in homeless' body lice from Algeria. We also report for the first time, the presence of several species of Acinetobacter in human body lice. Our results highlight the fact that body lice may be suspected as being a much broader vector of several pathogenic agents than previously thought. Nevertheless, other studies are needed to encourage epidemiological investigations and surveys of louse-associated infections.
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Affiliation(s)
- Meriem Louni
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- Laboratoire de Valorisation et Conservation des Ressources Biologiques (VALCORE), Faculté des Sciences, Université M’Hamed Bougara Boumerdes, Boumerdès, Algeria
| | - Nassima Mana
- Laboratoire Biodiversité et Environnement: Interactions, Génomes, Département de Biologie, Université des Sciences et Technologies Houari Boumediene, Bab Ezzouar, Algeria
| | - Idir Bitam
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- Laboratoire Biodiversité et Environnement: Interactions, Génomes, Département de Biologie, Université des Sciences et Technologies Houari Boumediene, Bab Ezzouar, Algeria
- Ecole Supérieure des Sciences de l'Aliment et des Industries Agro-Alimentaires, Algiers, Algeria
| | - Mustapha Dahmani
- Aix-Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Aix-Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Florence Fenollar
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Oleg Mediannikov
- Aix-Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- * E-mail:
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Candy K, Amanzougaghene N, Izri A, Brun S, Durand R, Louni M, Raoult D, Fenollar F, Mediannikov O. Molecular Survey of Head and Body Lice, Pediculus humanus, in France. Vector Borne Zoonotic Dis 2018; 18:243-251. [PMID: 29652646 DOI: 10.1089/vbz.2017.2206] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Human lice, Pediculus humanus, are obligate blood-sucking parasites. Phylogenetically, they belong to several mitochondrial clades exhibiting some geographic differences. Currently, the body louse is the only recognized disease vector, with the head louse being proposed as an additional vector. In this article, we study the genetic diversity of head and body lice collected from Bobigny, a town located close to Paris (France), and look for louse-borne pathogens. By amplifying and sequencing the cytb gene, we confirmed the presence of clades A and B in France. Besides, by amplifying and sequencing both cytb and cox1 gene, we reported, for the first time, the presence of clade E, which has thus far only been found in lice from West Africa. DNA from Bartonella quintana was detected in 16.7% of body lice from homeless individuals, but in none of the head lice collected from 47 families. Acinetobacter DNA was detected in 11.5% of head lice belonging to all three clades and 29.1% of body lice. Six species of Acinetobacter were identified, including two potential new ones. Acinetobacter baumannii was the most prevalent, followed by Candidatus Acinetobacter Bobigny-1, Acinetobacter calcoaceticus, Acinetobacter nosocomialis, Acinetobacter junii, and Candidatus Acinetobacter Bobigny-2. Body lice were found to be infected only with A. baumannii. These findings show for the first time, the presence of clade E head lice in France. This study is also the first to report the presence of DNAs of several species of Acinetobacter in human head lice in France.
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Affiliation(s)
- Kerdalidec Candy
- 1 Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne , Bobigny, France .,2 UMR "Émergence des Pathologies Virales" (EPV: Aix-Marseille University-IRD 190-Inserm 1207-EHESP-IHU Méditerranée Infection) , Marseille, France
| | - Nadia Amanzougaghene
- 3 IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University , Marseille, France
| | - Arezki Izri
- 1 Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne , Bobigny, France .,2 UMR "Émergence des Pathologies Virales" (EPV: Aix-Marseille University-IRD 190-Inserm 1207-EHESP-IHU Méditerranée Infection) , Marseille, France
| | - Sophie Brun
- 1 Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne , Bobigny, France
| | - Rémy Durand
- 1 Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne , Bobigny, France
| | - Meriem Louni
- 4 IRD, APHM, VITROME, IHU-Méditerranée Infection, Aix Marseille University , Marseille, France
| | - Didier Raoult
- 3 IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University , Marseille, France
| | - Florence Fenollar
- 4 IRD, APHM, VITROME, IHU-Méditerranée Infection, Aix Marseille University , Marseille, France
| | - Oleg Mediannikov
- 3 IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University , Marseille, France
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Gravinatti ML, Faccini-Martínez ÁA, Ruys SR, Timenetsky J, Biondo AW. Preliminary report of body lice infesting homeless people in Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e9. [PMID: 29451593 PMCID: PMC5813672 DOI: 10.1590/s1678-9946201860009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Álvaro A Faccini-Martínez
- Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | | | - Alexander Welker Biondo
- Departamento de Medicina Veterinária, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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44
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Leibler JH, León C, Cardoso LJP, Morris JC, Miller NS, Nguyen DD, Gaeta JM. Prevalence and risk factors for MRSA nasal colonization among persons experiencing homelessness in Boston, MA. J Med Microbiol 2017; 66:1183-1188. [PMID: 28771129 DOI: 10.1099/jmm.0.000552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Homeless individuals face an elevated risk of methicillin-resistant Staphylococcus aureus (MRSA) infection. Identifying the prevalence and risk factors for MRSA nasal colonization may reduce infection risk. A cross-sectional study was conducted at a health clinic for homeless persons in Boston, MA, USA (n=194). In-person interviews and nasal swab specimens were collected. MRSA isolates were genotyped using pulse-field gel electrophoresis (PFGE) and assessed for antibiotic susceptibility. The prevalence of MRSA nasal colonization was 8.3 %. Seventy-five percent of isolates reflected clonal similarity to USA300. USA100 (18.8 %) and USA500 (6.3 %) were also recovered. Resistance to erythromycin (81.3 %), levofloxacin (31.3 %) and clindamycin (23.1 %) was identified. Recent inpatient status, endocarditis, haemodialysis, heavy drinking, not showering daily and transience were positively associated with MRSA nasal colonization. Carriage of community-acquired MRSA strains predominated in this population, although nosocomial strains co-circulate. Attention to behavioural and hygiene-related risk factors, not typically included in MRSA prevention efforts, may reduce risk.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Casey León
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | | | - Jennifer C Morris
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Nancy S Miller
- Clinical Microbiology and Molecular Diagnostics Laboratory, Boston Medical Center, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel D Nguyen
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jessie M Gaeta
- Boston Health Care for the Homeless Program, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Kawecki S, Kuleck G, Dorsey JH, Leary C, Lum M. The prevalence of antibiotic-resistant bacteria (ARB) in waters of the Lower Ballona Creek Watershed, Los Angeles County, California. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:261. [PMID: 28488226 DOI: 10.1007/s10661-017-5964-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Screening for the prevalence of antibiotic-resistant bacteria (ARB) was done at the Ballona Creek and Wetlands, an urban-impacted wetland system in Los Angeles, California. The goals were (1) to assess the overall prevalence of ARB, and (2) compare differences in ARB abundance and the types of antibiotic resistance (AR) among the following sample types: lagoon water from Del Rey Lagoon, urban runoff from Ballona Creek, and water from the Ballona Wetlands (tidal water flooding in from the adjacent estuary, and ebbing out from the salt marsh). Antibiotic resistance distributions were analyzed using the Kolmogorov-Smirnov test to develop the cumulative frequency of bacteria having resistance of up to eight antibiotics. Distributions from the environmental water samples were compared to unchlorinated secondary effluent from the Hyperion Water Reclamation Plant that was used as comparator samples likely to have an abundance of ARB. As expected, densities of total and ARB were highest in secondary effluent, followed by urban runoff. Samples of water flooding into the wetlands showed similar results to urban runoff; however, a reduction in densities of total and ARB occurred in water ebbing out of the wetlands. During preliminary work to identify ARB species, several bacterial species of relevance to human illness (e.g., Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa, Aeromonas veronii, Enterobacter cancerogenus, Serratia marcescens, Pseudomonas stutzeri, and Staphylococcus intermedius) were isolated from sampled waters. If wetlands are a sink for ARB, construction and restoration of wetlands can help in the mediation of this human and environmental health concern.
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Affiliation(s)
- Stephanie Kawecki
- Loyola Marymount University, 1 LMU Drive, LSB 101, Los Angeles, CA, 90045, USA.
| | - Gary Kuleck
- University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI, 48221, USA
| | - John H Dorsey
- Loyola Marymount University, 1 LMU Drive, LSB 101, Los Angeles, CA, 90045, USA
| | - Christopher Leary
- Michael Baker International, 5050 Avenida Encinas, Suite 260, Carlsbad, CA, 92008, USA
| | - Michelle Lum
- Loyola Marymount University, 1 LMU Drive, LSB 101, Los Angeles, CA, 90045, USA
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46
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Dahlman D, Kral AH, Wenger L, Hakansson A, Novak SP. Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:29. [PMID: 28558841 PMCID: PMC5450090 DOI: 10.1186/s13011-017-0112-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022]
Abstract
Background People who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU. Methods PWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs. Results Almost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]). Conclusion Both pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.
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Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden. .,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden.
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Lynn Wenger
- Behavioral and Urban Health Program, RTI International, San Francisco, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Lund, Sweden.,Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4, SE-205 02, Malmo, Sweden
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47
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Abstract
Infectious disease has a major impact on the health outcomes of underserved populations and is reported at significantly higher rates among these populations compared with the general population. Overcoming barriers and obstacles to health care access is key to addressing the disparity regarding the prevalence of infectious disease. Enhancing cultural competency and educating practitioners about underserved populations' basic health needs; optimizing health insurance for the underserved; increasing community resources; and improving access to comprehensive, continuous, compassionate, and coordinated health care are strategies for diminishing the burden of infectious disease in underserved populations.
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Affiliation(s)
- Samuel Neil Grief
- Department of Family Medicine, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL 60612, USA.
| | - John Paul Miller
- Bakersfield Memorial Family Medicine Residency Program, Department of Family Medicine, University of California Irvine School of Medicine, 420 34th Street, Bakersfield, CA 93301, USA
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48
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Dahlman D, Håkansson A, Kral AH, Wenger L, Ball EL, Novak SP. Behavioral characteristics and injection practices associated with skin and soft tissue infections among people who inject drugs: A community-based observational study. Subst Abus 2016; 38:105-112. [PMID: 27897966 DOI: 10.1080/08897077.2016.1263592] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for bacterial skin and soft tissue infections (SSTIs). Although SSTIs pose significant health risks, little is known about their prevalence and characteristics in the population of PWID in the United States. This study investigates whether behavioral factors related to skin and equipment hygiene and tissue-damaging injection practices are associated with recent SSTIs among PWID. METHODS Active PWID were recruited using targeted sampling in San Francisco in 2011-2013. Interviewers collected information on behavioral risk factors of past-month self-reported SSTIs. Inferential analyses used multivariate logistic regression methods (i.e., generalized linear model) to characterize risk factors for past-month SSTIs. RESULTS The self-reported prevalence of lifetime, past-year, and past-month SSTI was 70%, 29%, and 11%, respectively. Several factors were significantly associated with past-month SSTIs in bivariate analysis, including injecting nonpowder drugs (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.23, 10.35; P = .01), needle-licking before injection (OR = 3.36; 95% CI = 1.28, 8.81; P = .01), injecting with someone else's preused syringe/needle (OR = 7.97; 95% CI = 2.46, 25.83; P < .001), being injected by another person (OR = 2.63; 95% CI = 1.02, 6.78; P = .04), infrequent skin cleaning before injection (OR = 2.47; 95% CI = 1.00, 6.10; P = .04), and frequent injections (P = .02). In multivariate analysis, only syringe/needle sharing (adjusted OR = 6.38; 95% CI = 1.90, 21.46) remained statistically significant. CONCLUSION SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment.
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Affiliation(s)
- Disa Dahlman
- a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.,b Malmö Addiction Centre, Skåne University Hospital , Malmö , Sweden
| | - Anders Håkansson
- a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.,b Malmö Addiction Centre, Skåne University Hospital , Malmö , Sweden
| | - Alex H Kral
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Lynn Wenger
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Elizabeth L Ball
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Scott P Novak
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
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49
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Dahlman D, Jalalvand F, Blomé MA, Håkansson A, Janson H, Quick S, Nilsson AC. High Perineal and Overall Frequency of Staphylococcus aureus in People Who Inject Drugs, Compared to Non-Injectors. Curr Microbiol 2016; 74:159-167. [PMID: 27896481 PMCID: PMC5243900 DOI: 10.1007/s00284-016-1165-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
Abstract
To investigate the prevalence, distribution, and colonization burden of Staphylococcus aureus (S. aureus) and MRSA in different body sites among people who inject drugs (PWID) and compare it to a control group consisting of non-injectors. In this cross-sectional survey, 49 active PWID from the needle exchange program (NEP) in Malmö, Sweden, and 60 non-injecting controls from an emergency psychiatric inpatient ward at Malmö Addiction Centre were tested for S. aureus (including MRSA) by culture, PCR, and MALDI-TOF. Samples were taken from anterior nares, throat, perineum, and skin lesions if present. Sixty-seven percent of the PWID were colonized with S. aureus, compared to 50% of the controls (P = 0.08). Perineal carriage was significantly more frequent among PWID than in the control group [37 vs 17%, OR 2.96 (95% CI 1.13-7.75), P = 0.03], also after adjusting for sex and age in multivariate analysis [OR 4.01 (95% CI 1.34-12.03)]. Only one individual in the whole cohort (NEP participant) tested positive for MRSA. PWID may be more frequently colonized with S. aureus in the perineum than non-injection drug users, and there was a trend indicating more frequent overall S. aureus colonization in PWID, as well as higher perineal colonization burden. No indication of a high MRSA prevalence among PWID in Sweden was noted. However, further MRSA prevalence studies among PWID are needed. Knowledge about S. aureus colonization is important for the prevention of S. aureus infections with high morbidity in PWID.
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Affiliation(s)
- Disa Dahlman
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Clinical Research Unit, Malmö Addiction Centre, Skåne University Hospital, Södra Förstadsg 35, Plan 4, 205 02, Malmö, Sweden.
| | | | - Marianne Alanko Blomé
- Infectious Disease Research Unit, Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Research Unit, Malmö Addiction Centre, Skåne University Hospital, Södra Förstadsg 35, Plan 4, 205 02, Malmö, Sweden
| | - Håkan Janson
- Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Susanne Quick
- Infectious Disease Research Unit, Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
| | - Anna C Nilsson
- Infectious Disease Research Unit, Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
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50
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Ottomeyer M, Graham CD, Legg AD, Cooper ES, Law CD, Molani M, Matevossian K, Marlin J, Williams C, Newman R, Wasserman JA, Segars LW, Taylor TAH. Prevalence of Nasal Colonization by Methicillin-Resistant Staphylococcus aureus in Persons Using a Homeless Shelter in Kansas City. Front Public Health 2016; 4:234. [PMID: 27826546 PMCID: PMC5078475 DOI: 10.3389/fpubh.2016.00234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/03/2022] Open
Abstract
Nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) plays an important role in the epidemiology and pathogenesis of disease. Situations of close-quarter contact in groups are generally regarded as a risk factor for community-acquired MRSA strains due to transmission via fomites and person-to-person contact. With these criteria for risk, homeless individuals using shelter facilities, including showers and toilets, should be considered high risk for colonization and infection. The aim of this study was to determine the prevalence of nasal colonization of MRSA in a homeless population compared to established rates of colonization within the public and a control group of subjects from a neighboring medical school campus, and to analyze phylogenetic diversity among the MRSA strains. Nasal samples were taken from the study population of 332 adult participants and analyzed. In addition, participants were surveyed about various lifestyle factors in order to elucidate potential patterns of behavior associated with MRSA colonization. Homeless and control groups both had higher prevalence of MRSA (9.8 and 10.6%, respectively), when compared to the general population reported by previous studies (1.8%). However, the control group had a similar MRSA rate compared to health-care workers (4.6%), while the homeless population had an increased prevalence. Risk factors identified in this study included male gender, age over 50 years, and use of antibiotics within the past 3 months. Phylogenetic relationships between nine of the positive samples from the homeless population were analyzed, showing eight of the nine samples had a high degree of relatedness between the spaA genes of the MRSA strains. This indicates that the same MRSA strain might be transmitted from person-to-person among homeless population. These findings increase our understanding of key differences in MRSA characteristics within homeless populations, as well as risks for MRSA associated with being homeless, such as age and gender, which may then be a useful tool in guiding more effective prevention, treatment, and health care for homeless individuals.
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Affiliation(s)
- Megan Ottomeyer
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Charles D Graham
- Department of Internal Medicine, University of Nevada School of Medicine , Reno, NV , USA
| | - Avery D Legg
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City , Kansas City, MO , USA
| | - Elizabeth S Cooper
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Chad D Law
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Mariam Molani
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Karine Matevossian
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Jerry Marlin
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | | | - Ramon Newman
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Jason A Wasserman
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine , Rochester, MI , USA
| | - Larry W Segars
- Kansas City University of Medicine and Biosciences , Kansas City, MO , USA
| | - Tracey A H Taylor
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine , Rochester, MI , USA
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