Communicable disease among people experiencing homelessness in California

Abstract

California has a large population of people experiencing homelessness (PEH) that is characterised by a high proportion of people who are unsheltered and chronically homeless. PEH are at increased risk of communicable diseases due to multiple, intersecting factors, including increased exposures, comorbid conditions including substance use disorder and mental illness and lack of access to hygiene and healthcare facilities. Data available for several communicable diseases show that PEH in California experiences an increased burden of communicable diseases compared to people not experiencing homelessness. Public health agencies face unique challenges in serving this population. Efforts to reduce homelessness, increase access to health care for PEH, enhance data availability and strengthen partnerships among agencies serving PEH can help reduce the disparity in communicable disease burden faced by PEH.

Public toilets have reduced enteric pathogen hazards in San Francisco

“…Nearly 130,000 people in California experience homelessness each day, and they are disproportionately unsheltered compared to those in other states 1, 4 . Like many US cities, San Francisco does not have enough public toilets to meet demand 5 .…”

Trends in COVID-19 vaccination intent and factors associated with deliberation and reluctance among adult homeless shelter residents and staff, 1 November 2020 to 28 February 2021 – King County, Washington

“…Challenges to reduce severe outcomes related to COVID-19 include access to COVID-19 vaccination [6] , [7] , [8] and a history of disproportionately low vaccine intent among PEH. [7] , [9] , [10] An understanding of vaccination intent—defined here as planning to get the COVID-19 vaccine—is important to tailor vaccine campaign strategies to maximize improvements in socio-culturally informed vaccine uptake.…”

COVID-19 vaccine access and attitudes among people experiencing homelessness from pilot mobile phone survey in Los Angeles, CA

“…In this particular case, the triple burden of chronic disease comorbidity, stigmatized exclusion from health systems, and pathogenic exposure create the potential conditions for recurrent epidemics and disease evolution [19]. The emergence of highly transmissible variants, combined with reduced attention to protective interventions, could lead to evolution in a subpopulation that has already been affected by recent outbreaks of Hepatitis A, tuberculosis, and typhus [20,21]. Successful efforts to convince unhoused people of the benefits of vaccination, while requiring painstaking effort, could yield short-term benefits to both unhoused and housed communities, and promote resiliency to future pandemics and other disasters.…”