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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 2024:333549241228525. [PMID: 38379269 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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2
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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [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: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Bien MB, Whitton A, Meehan A, Thornhill L, Ellis K, Leopold J, Borne D, Vickery KD, Imbert E, Twohey-Jacobs L, Perez KA, Mosites E. Strengthening Public Health Capacity to Address Infectious Diseases: Lessons From 3 Centers of Excellence in Public Health and Homelessness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:775-779. [PMID: 37738595 PMCID: PMC10552800 DOI: 10.1097/phh.0000000000001830] [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: 09/24/2023]
Abstract
People experiencing homelessness are disproportionately affected by infectious diseases and often face barriers to receiving appropriate medical treatment. Responding to the needs of people experiencing homelessness requires state and local health departments to integrate information sources and coordinate multisector efforts. From 2021 to 2023, the CDC Foundation, in cooperation with the Centers for Disease Control and Prevention, established pilot Centers of Excellence in Public Health and Homelessness in Seattle, Washington; San Francisco, California; and the state of Minnesota. These centers strengthened their capacity to address the needs of people experiencing homelessness by supporting cross-sector partnerships, assessing the interoperability of data systems, prioritizing infectious disease needs, and identifying health disparities. These programs demonstrated that health departments are heterogeneous entities with differing resources and priorities. They also showed the importance of employing dedicated public health staff focused on homelessness, establishing diverse partnerships and the need for support from local leaders to address homelessness.
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Affiliation(s)
- Michael B. Bien
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Alaina Whitton
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Ashley Meehan
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Lee Thornhill
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Karin Ellis
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Josh Leopold
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Deborah Borne
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Katherine Diaz Vickery
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Elizabeth Imbert
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Lorraine Twohey-Jacobs
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Kenneth A. Perez
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Emily Mosites
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
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Taylor SN, Munson D. Health Care of People Experiencing Homelessness: Part I. NEJM EVIDENCE 2023; 2:EVIDra2300123. [PMID: 38320148 DOI: 10.1056/evidra2300123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Homelessness and Health CarePeople who experience homelessness have high rates of medical illness. They struggle with conditions associated with living in crowded shelters, trauma, and exposure to extreme weather. Here, Taylor and Munson review the care of this vulnerable population.
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Affiliation(s)
| | - David Munson
- Massachusetts General Hospital, Boston
- Boston Health Care for the Homeless Program, Boston
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5
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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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6
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Raz KM, Talarico S, Althomsons SP, Kammerer JS, Cowan LS, Haddad MB, McDaniel CJ, Wortham JM, France AM, Powell KM, Posey JE, Silk BJ. Molecular surveillance for large outbreaks of tuberculosis in the United States, 2014-2018. Tuberculosis (Edinb) 2022; 136:102232. [PMID: 35969928 PMCID: PMC9530005 DOI: 10.1016/j.tube.2022.102232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study describes characteristics of large tuberculosis (TB) outbreaks in the United States detected using novel molecular surveillance methods during 2014-2016 and followed for 2 years through 2018. METHODS We developed 4 genotype-based detection algorithms to identify large TB outbreaks of ≥10 cases related by recent transmission during a 3-year period. We used whole-genome sequencing and epidemiologic data to assess evidence of recent transmission among cases. RESULTS There were 24 large outbreaks involving 518 cases; patients were primarily U.S.-born (85.1%) racial/ethnic minorities (84.1%). Compared with all other TB patients, patients associated with large outbreaks were more likely to report substance use, homelessness, and having been diagnosed while incarcerated. Most large outbreaks primarily occurred within residences among families and nonfamilial social contacts. A source case with a prolonged infectious period and difficulties in eliciting contacts were commonly reported contributors to transmission. CONCLUSION Large outbreak surveillance can inform targeted interventions to decrease outbreak-associated TB morbidity.
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Affiliation(s)
- Kala M Raz
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sarah Talarico
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Lauren S Cowan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maryam B Haddad
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Krista M Powell
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James E Posey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Silk
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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7
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Scarlett H, Melchior M, Davisse-Paturet C, Aarbaoui TE, Longchamps C, Figueiredo N, Ducarroz S. Substance Use Among Residents of Homeless Shelters During the COVID-19 Pandemic: Findings From France. Int J Public Health 2022; 67:1604684. [PMID: 36090832 PMCID: PMC9452639 DOI: 10.3389/ijph.2022.1604684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: To record the prevalence and risk factors of substance use amongst homeless persons during the COVID-19 pandemic. Methods: The ECHO study consisted in two independent cross-sectional waves of data collection in the regions of Paris, Lyon, and Strasbourg during the Spring of 2020 (n = 530) and 2021 (n = 319). Factors associated with substance use were explored using generalised logistic regression models. Results: The most prevalent substance used was tobacco (38%–43%), followed by alcohol (26%–34%). The use of both substances positively associated with each other, although risk factors varied depending on the substance. The only factors consistently associated with alcohol and tobacco use were being male, exposure to theft/assault and participants’ region of origin. Whilst the rate of tobacco use was relatively stable between Spring 2020 and 2021, alcohol use was more common in 2021. Conclusion: These findings highlight a high prevalence of substance use amongst homeless persons. People experiencing homelessness face specific challenges in the context of the pandemic, alongside greater vulnerability to illness and low healthcare access, therefore the need to improve prevention and support services for substance abuse within this population is vital.
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Affiliation(s)
- Honor Scarlett
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
| | - Camille Davisse-Paturet
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Tarik El. Aarbaoui
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Cécile Longchamps
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Simon Ducarroz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
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8
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Farnish KA, Schoenfeld EA. Implications of the COVID-19 Pandemic for Youth Housing and Homelessness Services. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 41:1-20. [PMID: 35345536 PMCID: PMC8943111 DOI: 10.1007/s10560-022-00830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19-as well as challenges and facilitators to service delivery-were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.
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Affiliation(s)
| | - Elizabeth A. Schoenfeld
- LifeWorks, 835 N. Pleasant Valley Road, Austin, TX 78702 USA
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, USA
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9
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Aranda-Díaz A, Imbert E, Strieff S, Graham-Squire D, Evans JL, Moore J, McFarland W, Fuchs J, Handley MA, Kushel M. Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters. PLoS One 2022; 17:e0264929. [PMID: 35271622 PMCID: PMC8912252 DOI: 10.1371/journal.pone.0264929] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. Methods We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. Results Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project’s initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. Conclusion Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.
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Affiliation(s)
- Andrés Aranda-Díaz
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Elizabeth Imbert
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
| | - Sarah Strieff
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Dave Graham-Squire
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jennifer L. Evans
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jamie Moore
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jonathan Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Margaret A. Handley
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- UCSF PRISE Center: Partnerships for Research in Implementation Science for Equity, San Francisco, California, United States of America
| | - Margot Kushel
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
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10
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Fields VL, Kiphibane T, Eason JT, Hafoka SF, Lopez AS, Schwartz A, Henry A, Tran CH, Tate JE, Kirking HL, Laws RL, Venkatappa T, Mosites E, Montgomery MP. Assessment of contact tracing for COVID-19 among people experiencing homelessness, Salt Lake County Health Department, March-May 2020. Ann Epidemiol 2021; 59:50-55. [PMID: 33894384 PMCID: PMC8061086 DOI: 10.1016/j.annepidem.2021.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Contact tracing is intended to reduce the spread of coronavirus disease 2019 (COVID-19), but it is difficult to conduct among people who live in congregate settings, including people experiencing homelessness (PEH). This analysis compares person-based contact tracing among two populations in Salt Lake County, Utah, from March-May 2020. METHODS All laboratory-confirmed positive cases among PEH (n = 169) and documented in Utah's surveillance system were included in this analysis. The general population comparison group (n = 163) were systematically selected from all laboratory-confirmed cases identified during the same period. RESULTS Ninety-three PEH cases (55%) were interviewed compared to 163 (100%) cases among the general population (P < .0001). PEH were more likely to be lost to follow-up at end of isolation (14.2%) versus the general population (0%; P-value < .0001) and provided fewer contacts per case (0.3) than the general population (4.7) (P-value < .0001). Contacts of PEH were more often unreachable (13.0% vs. 7.1%; P-value < .0001). CONCLUSIONS These findings suggest that contact tracing among PEH should include a location-based approach, along with a person-based approach when resources allow, due to challenges in identifying, locating, and reaching cases among PEH and their contacts through person-based contact tracing efforts alone.
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Affiliation(s)
| | | | | | | | | | - Amy Schwartz
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Ankita Henry
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Cuc H Tran
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Emily Mosites
- Centers for Disease Control and Prevention, Atlanta, GA
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11
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Self JL, McDaniel CJ, Bamrah Morris S, Silk BJ. Estimating and Evaluating Tuberculosis Incidence Rates Among People Experiencing Homelessness, United States, 2007-2016. Med Care 2021; 59:S175-S181. [PMID: 33710092 PMCID: PMC8324075 DOI: 10.1097/mlr.0000000000001466] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Persons experiencing homelessness (PEH) are disproportionately affected by tuberculosis (TB). We estimate area-specific rates of TB among PEH and characterize the extent to which available data support recent transmission as an explanation of high TB incidence. METHODS We estimated TB incidence among PEH using National Tuberculosis Surveillance System data and population estimates for the US Department of Housing and Urban Development's Continuums of Care areas. For areas with TB incidence higher than the national average among PEH, we estimated recent transmission using genotyping and a plausible source-case method. For cases with ≥1 plausible source case, we assessed with TB program partners whether available whole-genome sequencing and local epidemiologic data were consistent with recent transmission. RESULTS During 2011-2016, 3164 TB patients reported experiencing homelessness. National incidence was 36 cases/100,000 PEH. Incidence estimates varied among 21 areas with ≥10,000 PEH (9-150 cases/100,000 PEH); 9 areas had higher than average incidence. Of the 2349 cases with Mycobacterium tuberculosis genotyping results, 874 (37%) had ≥1 plausible source identified. In the 9 areas, 23%-82% of cases had ≥1 plausible source. Of cases with ≥1 plausible source, 63% were consistent and 7% were inconsistent with recent transmission; 29% were inconclusive. CONCLUSIONS Disparities in TB incidence for PEH persist; estimates of TB incidence and recent transmission vary by area. With a better understanding of the TB risk among PEH in their jurisdictions and the role of recent transmission as a driver, programs can make more informed decisions about prioritizing TB prevention strategies.
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Affiliation(s)
- Julie L Self
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA
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12
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Perri M, Dosani N, Hwang SW. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ 2020; 192:E716-E719. [PMID: 32601252 DOI: 10.1503/cmaj.200834] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Naheed Dosani
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
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13
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Breeher L, Boon A, Hainy C, Murad MH, Wittich C, Swift M. A Framework for Sustainable Contact Tracing and Exposure Investigation for Large Health Systems. Mayo Clin Proc 2020; 95:1432-1444. [PMID: 32561146 PMCID: PMC7832466 DOI: 10.1016/j.mayocp.2020.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022]
Abstract
Contact tracing is a cornerstone of communicable disease containment and involves identifying, quarantining, and monitoring contacts of infected people. Although contact tracing is a known evidence-based strategy in the community setting, the COVID-19 pandemic highlighted the challenges to implementing labor-intensive contact tracing in the occupational setting of large health care systems and hospitals, the epicenter of the pandemic. We present a framework for feasible, scalable COVID-19 contact tracing in a large multistate health system in the United States employing approximately 69,000 health care personnel. The framework is shared with sufficient details to allow adoption or adaptation by other health systems. Continuous enhancement, optimization, and evaluation of the framework are ongoing.
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Affiliation(s)
- Laura Breeher
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN; Occupational Health Services, Mayo Clinic, Rochester, MN.
| | - Ashton Boon
- Legal Department, Mayo Clinic, Rochester, MN
| | - Caitlin Hainy
- Occupational Health Services, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | | | - Melanie Swift
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
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