Summary
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by
the hepatitis A virus (HAV). The infection is transmitted via the fecal-oral route,
usually from direct person-to-person contact or consumption of contaminated food or
water. Hepatitis A is an acute, self-limited disease that does not result in chronic
infection. HAV antibodies (immunoglobulin G [IgG] anti-HAV) produced in response to HAV
infection persist for life and protect against reinfection; IgG anti-HAV produced after
vaccination confer long-term immunity. This report supplants and summarizes previously
published recommendations from the Advisory Committee on Immunization Practices (ACIP)
regarding the prevention of HAV infection in the United States. ACIP recommends routine
vaccination of children aged 12–23 months and catch-up vaccination for children
and adolescents aged 2–18 years who have not previously received hepatitis A
(HepA) vaccine at any age. ACIP recommends HepA vaccination for adults at risk for HAV
infection or severe disease from HAV infection and for adults requesting protection
against HAV without acknowledgment of a risk factor. These recommendations also provide
guidance for vaccination before travel, for postexposure prophylaxis, in settings
providing services to adults, and during outbreaks
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
In-person learning benefits children and communities (1). Understanding the context in which transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), occurs in schools is critical to improving the safety of inperson learning.
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