Public Health Response to Tuberculosis Outbreak among Persons Experiencing Homelessness, Minneapolis, Minnesota, USA, 2017–2018

Abstract

I n 2017, a total of 9,093 new cases of active tuberculosis (TB) were reported in the United States, and ≈4.5% of these occurred in persons experiencing homelessness (PEH) in the year preceding their diagnosis (1). The incidence of TB in PEH populations is >10 times that of the general population (i.e., 36-47 vs. 2.8 cases/100,000 population during 2006-2010) (2) because risk factors, such as HIV infection, mental illness, substance abuse, and barriers to accessing healthcare, put them at higher risk. In addition, PEH often use homeless shelters, and congregate in

Assessment of contact tracing for COVID-19 among people experiencing homelessness, Salt Lake County Health Department, March–May 2020

“…Limiting movement may help reduce the large number of PEH who could not be located or contacted. Leveraging partnerships that provide services to shelters, routinely collecting and maintaining records of shelter residents, providing educational interventions, and implementing administrative controls and policy changes are among approaches taken to facilitate contact investigations and reduce the severity of tuberculosis outbreaks [ 10 , 11 , 12 ]. Similar approaches can be adapted for COVID-19.…”

COVID-19 and people experiencing homelessness: challenges and mitigation strategies

“…7,8 The risk of severe COVID-19 is increased for people experiencing homelessness owing to the high prevalence of medical comorbidities including heart disease, respiratory conditions, liver disease and high rates of smoking in homeless populations. [9][10][11] An increasing proportion of people experiencing homelessness are older than 65 years, a factor that also exacerbates the risk of developing severe COVID-19. 12 Given these factors, modelling of the potential effect of SARS-CoV-2 among the US homeless population showed a potential peak infection rate of 40%, with an estimated 4.3% of individuals who experience homelessness likely to require admission to hospital.…”

Substance Use Among Residents of Homeless Shelters During the COVID-19 Pandemic: Findings From France

“…Our findings then suggest a rate amongst homeless persons roughly double that of the general population. Considering that homeless persons present higher rates of medical comorbidities [ 25 , 26 , 45 ] and are therefore more at risk of tobacco-related illness or fatality [ 26 , 46 ], these findings are cause for concern. Additionally, despite universal health care, socioeconomically disadvantaged groups are less likely to have access to smoking cessation programs, leading to large inequalities in smoking which appear to have increased in the context of the COVID-19 pandemic [ 47 ].…”