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Not tackling infections in homeless could spark epidemics

Tuberculosis 34 times higher in homeless people

Adrian O'Dowd

Monday, 20 August 2012

Public heath efforts are badly needed to tackle high rates of infectious diseases amongst the homeless population, according to a new systematic review of existing data published online today in The Lancet Infectious Diseases.

Failure to do so will not only run the risk of epidemics breaking out among this part of the population but also pose a public health challenge for the whole population.

The study, which examined more than 40 research papers assessing the levels of HIV, hepatitis C and tuberculosis among homeless people from 1984 to 2012, found that rates of these infectious diseases among the world’s homeless people were many times higher than in the general population.

Although there is considerable variation between countries and regions, homeless people have a much higher likelihood of having one of these potentially fatal and debilitating diseases.

There are thought to be around 380,000 homeless people in the UK and more than 650,000 in the US with rates of youth homelessness rising in the UK and family homelessness increasing in the US.

In the UK, the prevalence of tuberculosis is at least 34 times greater in homeless people than in the general population, and the prevalence of hepatitis C viral infection is nearly 50 times greater.

In the US, the prevalence of tuberculosis is at least 46 times greater in the homeless population than the general population, and the prevalence of hepatitis C viral infection is increased more than fourfold.

For HIV, they were typically 1-20 fold higher in US homeless people than the general population, but no studies were found in the UK.

In addition, high rates of other infectious diseases – such as hepatitis A and B, diphtheria, foot problems and skin infections – have been reported in some studies.

Senior author, Dr Seena Fazel, a Wellcome Trust senior research fellow in clinical science at the University of Oxford said: “Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness, and high use of medical services.

“Because absolute numbers of homeless people are high in some countries, improvements in care could have pronounced effects on public health.”

The authors said a more active approach to identifying tuberculosis patients in particular was needed.

Dr Fazel added: “Screening for tuberculosis should be done through active case-finding—it should not be restricted to symptomatic people presenting to health services, which happens less and later in marginalised groups than in general populations.”

More effective treatment and management should be considered including syringe and needle exchange programmes, first-aid centres in large cities, and annual snapshot interventions of homeless populations.

In a linked comment, Dr Didier Raoult of the University of Aix-Marseille, France, said: “Targeted actions are needed to address the susceptibility of homeless people to infection. The risks of epidemics of infectious diseases in homeless populations remain significantly higher than those in the general population in the same country.

“These increased risks are a public health challenge for the population as a whole. Implementation of specific strategies to reduces these risks is crucial.”


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