Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015

Abstract

The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002–2015. We used data from the Centers for Disease Control and Prevention’s Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group.

Vaccine-preventable diseases other than tuberculosis, and homelessness: A systematic review of the published literature, 1980 to 2020

“…Thirteen studies concerning pneumococcal infections in homeless people were retrieved between 1988 and 2017 (including one unpublished data set) [2, 68-78]: 12 studies were conducted in adults (mean age: 19-54 years, range 16-78 years) and one in a population comprising children and adults (mean age: 42 years, range 0-90 years). Most studies were conducted in Canada (n=8) [68, 70-76], followed by France (n=3, including one unpublished data set) [2, 78], and the USA (n=2) [69, 77]. Two molecular prevalence surveys reported rates of 12.4% and 15.5% for pneumococcal nasopharyngeal carriage among a total of 575 sheltered homeless persons in Marseille, France between 2015-2018 (including one unpublished data set) [2], and prevalence was positively associated with respiratory symptoms and signs.…”

“…Two molecular prevalence surveys reported rates of 12.4% and 15.5% for pneumococcal nasopharyngeal carriage among a total of 575 sheltered homeless persons in Marseille, France between 2015-2018 (including one unpublished data set) [2], and prevalence was positively associated with respiratory symptoms and signs. Other studies described eleven outbreaks of invasive pneumococcal disease (IPD) occurring in different cities in Canada, the USA and France; of those, two studies reported 153 homeless individuals hospitalised with IPD, which accounted for 1.4%-8.4% of all homeless people present in two cities, Toronto (Canada) and Anchorage (USA) [76, 77]; nine other studies reported a high proportion (4.7%-48.8%) of homelessness among 4742 individuals hospitalised with IPD [68-75, 78]. Homeless individuals with IDP were typically younger [73, 77], more often male [73], smokers[73, 75, 76], alcohol abusers [73, 75, 77], illegal drug users [73, 75], and had a primary diagnosis of pneumonia [73], HIV infection or liver disease [76] when compared with non-homeless individuals.…”

“…Other studies described eleven outbreaks of invasive pneumococcal disease (IPD) occurring in different cities in Canada, the USA and France; of those, two studies reported 153 homeless individuals hospitalised with IPD, which accounted for 1.4%-8.4% of all homeless people present in two cities, Toronto (Canada) and Anchorage (USA) [76, 77]; nine other studies reported a high proportion (4.7%-48.8%) of homelessness among 4742 individuals hospitalised with IPD [68-75, 78]. Homeless individuals with IDP were typically younger [73, 77], more often male [73], smokers[73, 75, 76], alcohol abusers [73, 75, 77], illegal drug users [73, 75], and had a primary diagnosis of pneumonia [73], HIV infection or liver disease [76] when compared with non-homeless individuals. Of nine studies, two characterising the serotype of isolated Streptococcus pneumoniae strains showed that serotypes 1, 4, 5, 8 and 12F were positively associated with homelessness in Canada [68, 70, 72].…”

Streptococcus: An organism causing diseases beyond neglect

“…The reported incidence rates of ISD are increasing significantly in developed nations such as Canada and New Zealand [9,10]. Homelessness and other measures of disadvantage are significant risk factors [9][10][11]. Within developed countries, indigenous populations suffer some of the highest reported rates of ISD.…”

Interventions to Deliver Vaccination to, and Improve Vaccination Rates in, People who are Homeless

“…In comparison to the general population, people who are homeless experience poorer health and health-related outcomes. People who are homeless are at greater risk of developing a range of mental and physical illnesses, including vaccine-preventable diseases such as hepatitis (Hosseini & Ding, 2018;Noska et al, 2017;Peak et al, 2019), pneumococcal disease (Lemay et al, 2019;McKee et al, 2018;Mosites et al, 2019) and tuberculosis (Bamrah et al, 2013;Khan et al, 2011;Lee et al, 2013;Romaszko et al, 2013). Once ill, people who are homeless have a greater likelihood of hospitalisation, intensive care unit (ICU) admission, and death (Lewer et al, 2020).…”