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Rich SN, Carpenter A, Dell B, Henderson R, Adams S, Bestul N, Grano C, Sprague B, Leopold J, Schiffman EK, Lomeli A, Zadeh H, Alarcón J, Halai UA, Nam YS, Seifu L, Slavinski S, Crum D, Mosites E, Salzer JS, Hinckley AF, McCormick DW, Marx GE. Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States. Zoonoses Public Health 2024. [PMID: 38514461 DOI: 10.1111/zph.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. METHODS AND RESULTS Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. CONCLUSIONS Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.
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Affiliation(s)
- Shannan N Rich
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Ann Carpenter
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bree Dell
- Communicable Disease Epidemiology & Immunization Section, Public Health - Seattle & King County, Seattle, Washington State, USA
| | - Rachel Henderson
- University of Colorado Anschutz Medical Campus at Colorado State University, Fort Collins, Colorado, USA
| | - Sydney Adams
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - Nicolette Bestul
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher Grano
- Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Briana Sprague
- Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Josh Leopold
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Elizabeth K Schiffman
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Andrea Lomeli
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA
| | - Hassan Zadeh
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA
| | - Jemma Alarcón
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Umme-Aiman Halai
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Yoon-Sung Nam
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Leah Seifu
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Sally Slavinski
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - David Crum
- Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Emily Mosites
- Office of the Director, Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Johanna S Salzer
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison F Hinckley
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - David W McCormick
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace E Marx
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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