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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Liang Y, Sun Q, Liu Q, Pang Y, Tang S. SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population: a systematic review and meta-analysis. Front Public Health 2023; 11:1044788. [PMID: 37900041 PMCID: PMC10600393 DOI: 10.3389/fpubh.2023.1044788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives SARS-CoV-2 infection and COVID-19 vaccination of homeless people are a serious public health concern during COVID-19 pandemic. We aimed to systematically assess SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in homeless people, which are important to inform resource allocation and policy adjustment for the prevention and control of COVID-19. Methods We searched PubMed, Web of Science, and the World Health Organization COVID-19 database for the studies of SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population. Subgroup analyses were conducted to pool SARS-CoV-2 incidence and seroprevalence in sheltered homeless, unsheltered homeless, and mixed population, respectively. Potential sources of heterogeneity in the estimates were explored by meta-regression analysis. Results Forty-nine eligible studies with a total of 75,402 homeless individuals and 5,000 shelter staff were included in the meta-analysis. The pooled incidence of SARS-CoV-2 infection was 10% (95% CI: 7 to 12%) in the homeless population and 8% (5 to 12%) for shelter staff. In addition, the overall estimated SARS-CoV-2 specific seroprevalence was 19% (8 to 33%) for homeless populations and 22% (3 to 52%) for shelter staff, respectively. Moreover, for the homeless subjects, the pooled incidence was 10% (4 to 23%) for asymptomatic SARS-CoV-2 infections, 6% (1 to 12%) for symptomatic SARS-CoV-2 infections, 3% (1 to 4%) for hospitalization for COVID-19, and 1% (0 to 2%) for severe COVID-19 cases, respectively while no COVID-19-related death was reported. Furthermore, the data derived from 12 included studies involving 225,448 homeless individuals revealed that the pooled proportion of one dose COVID-19 vaccination was 41% (35 to 47%), which was significantly lower than those in the general population. Conclusion Our study results indicate that the homeless people remain highly susceptible to SARS-CoV-2 infection, but COVID-19 vaccination coverage was lower than the general population, underscoring the need for prioritizing vaccine deployment and implementing enhanced preventive measures targeting this vulnerable group.
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Affiliation(s)
| | | | | | | | - Shixing Tang
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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Ogbonna O, Bull F, Spinks B, Williams D, Lewis R, Edwards A. The Impact of Being Homeless on the Clinical Outcomes of COVID-19: Systematic Review. Int J Public Health 2023; 68:1605893. [PMID: 37780134 PMCID: PMC10540688 DOI: 10.3389/ijph.2023.1605893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Objective: The homeless population experiences inequality in health compared with the general population, which may have widened during the COVID-19 pandemic. However, the impact of being homeless on the outcomes of COVID-19 is uncertain. This systematic review aimed to analyse the impact of experiencing homelessness on the clinical outcomes of COVID-19, including the effects on health inequalities. Methods: A review protocol was developed and registered in PROSPERO (PROSPERO registration 2022 CRD42022304941). Nine databases were searched in November 2022 to identify studies on homeless populations which contained primary research on the following outcomes of COVID-19: incidence, hospitalisation, mortality, long COVID, mental wellbeing, and evidence of inequalities. Included studies were summarised with narrative synthesis. Results: The searches yielded 8,233 initial hits; after screening, 41 studies were included. Overall, evidence showed that those in crowded living settings had a higher risk of COVID-19 infection compared to rough sleepers and the general population. The homeless population had higher rates of hospitalisation and mortality than the general population, lower vaccination rates, and suffered negative mental health impacts. Conclusion: This systematic review shows the homeless population is more susceptible to COVID-19 outcomes. Further research is needed to determine the actual impact of the pandemic on this population, and of interventions to mitigate overall risk, given the low certainty of findings from some of the low-quality evidence available. In addition, further research is required to ascertain the impact of long COVID on those experiencing homelessness, since the present review yielded no studies on this topic.
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Affiliation(s)
- Obianuju Ogbonna
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Francesca Bull
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Bethany Spinks
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Denitza Williams
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Adrian Edwards
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Levesque J, Babando J, Loranger N, Johnson S, Pugh D. COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review. Syst Rev 2022; 11:223. [PMID: 36243764 PMCID: PMC9569412 DOI: 10.1186/s13643-022-02089-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately impacted homeless populations and service workers, especially within homeless shelter/hostel settings. To date, there have been few evidence syntheses examining outbreaks of COVID-19 among both homeless shelter residents and service workers and no critical review of infection control and prevention (IPAC) measures. This scoping review offers a much-needed synthesis of COVID-19 prevalence within homeless shelters and a review of pertinent IPAC measures. METHODS: We conducted a scoping review that aimed to synthesize academic and gray literature published from March 2020 to July 2021 pertaining to (1) the prevalence of COVID-19 among both residents and staff in homeless shelters and hostels in high-income countries and (2) COVID-19 IPAC strategies applied in these settings. Two reviewers independently screened the literature from several databases that included MEDLINE, PsycInfo, and the WHO's COVID-19 Global Health Portal. The extracted data was mapped, categorized, and thematically discussed. RESULTS Thematic analysis of 77 academic and gray literature documents revealed four key themes: (1) the demographics of COVID-19 in homeless shelters, (2) asymptomatic spread, (3) pre-existing vulnerability of people experiencing homelessness and shelters, and (4) the inconsistency and ineffectiveness of IPAC implementation. CONCLUSION This review offers a useful glimpse into the landscape of COVID-19 outbreaks in homeless shelters/hostels and the major contributing factors to these events. This review revealed that there is no clear indication of generally accepted IPAC standards for shelter residents and workers. This review also illustrated a great need for future research to establish IPAC best practices specifically for homeless shelter/hostel contexts. Finally, the findings from this review reaffirm that homelessness prevention is key to limiting disease outbreaks and the associated negative health outcomes in shelter populations. Limitations of this review included the temporal and database constraints of the search strategy, the exclusion of quality assessments of the literature, and the absence of investigation on the influence of emerging variants on public health policy. SYSTEMATIC REVIEW REGISTRATION This scoping review has not been registered on any database; the protocol is available on York University's Institutional Repository https://dx.doi.org/10.25071/10315/38513 .
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Affiliation(s)
- Justine Levesque
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - Jordan Babando
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Nathaniel Loranger
- York University School of Social Work, S880 Ross Building, 4700 Keele St, Toronto, ON, M3J1P3, Canada
| | - Shantel Johnson
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - David Pugh
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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Chow EJ, Casto AM, Roychoudhury P, Han PD, Xie H, Pfau B, Nguyen TV, Sereewit J, Rogers JH, Cox SN, Wolf CR, Rolfes MA, Mosites E, Uyeki TM, Greninger AL, Hughes JP, Shim MM, Sugg N, Duchin JS, Starita LM, Englund JA, Chu HY. The Clinical and Genomic Epidemiology of Rhinovirus in Homeless Shelters-King County, Washington. J Infect Dis 2022; 226:S304-S314. [PMID: 35749582 PMCID: PMC9384451 DOI: 10.1093/infdis/jiac239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Rhinovirus (RV) is a common cause of respiratory illness in all people, including those experiencing homelessness. RV epidemiology in homeless shelters is unknown. METHODS We analyzed data from a cross-sectional homeless shelter study in King County, Washington, October 2019-May 2021. Shelter residents or guardians aged ≥3 months reporting acute respiratory illness completed questionnaires and submitted nasal swabs. After 1 April 2020, enrollment expanded to residents and staff regardless of symptoms. Samples were tested by multiplex RT-PCR for respiratory viruses. A subset of RV-positive samples was sequenced. RESULTS There were 1066 RV-positive samples with RV present every month of the study period. RV was the most common virus before and during the coronavirus disease 2019 (COVID-19) pandemic (43% and 77% of virus-positive samples, respectively). Participants from family shelters had the highest prevalence of RV. Among 131 sequenced samples, 33 RV serotypes were identified with each serotype detected for ≤4 months. CONCLUSIONS RV infections persisted through community mitigation measures and were most prevalent in shelters housing families. Sequencing showed a diversity of circulating RV serotypes, each detected over short periods of time. Community-based surveillance in congregate settings is important to characterize respiratory viral infections during and after the COVID-19 pandemic. CLINICAL TRIALS REGISTRATION NCT04141917.
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Affiliation(s)
- Eric J Chow
- Corresponding author: Eric J. Chow, MD, MS, MPH, Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street Box 356423, S512020125, Washington 98195, E-mail: , Ph:206-685-4456, Fax:206-616-3892
| | - Amanda M Casto
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle (98195), Washington, USA,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle (98109), Washington, USA
| | - Pavitra Roychoudhury
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle (98109), Washington, USA,Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle (98195), Washington, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, Seattle (98195), Washington, USA,Department of Genome Sciences, University of Washington, Seattle (98195), Washington, USA
| | - Hong Xie
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle (98195), Washington, USA
| | - Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle (98195), Washington, USA,Department of Genome Sciences, University of Washington, Seattle (98195), Washington, USA
| | - Tien V Nguyen
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle (98195), Washington, USA
| | - Jaydee Sereewit
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle (98195), Washington, USA
| | - Julia H Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle (98195), Washington, USA,Department of Epidemiology, University of Washington, Seattle (98195), Washington, USA
| | - Sarah N Cox
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle (98195), Washington, USA,Department of Epidemiology, University of Washington, Seattle (98195), Washington, USA
| | - Caitlin R Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle (98195), Washington, USA
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta (30333), Georgia, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (30333), Georgia, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta (30333), Georgia, USA
| | - Alexander L Greninger
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle (98109), Washington, USA,Department of Laboratory Medicine and Pathology, University of Washington, Seattle (98195), Washington, USA
| | - James P Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle (98109), Washington, USA,Department of Biostatistics, University of Washington, Seattle (98105), Washington, USA
| | - M Mia Shim
- Public Health – Seattle & King County, Seattle (98104), Washington, USA,Department of Medicine, University of Washington, Seattle (98195), Washington, USA
| | - Nancy Sugg
- Department of Medicine, University of Washington, Seattle (98195), Washington, USA
| | - Jeffrey S Duchin
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle (98195), Washington, USA,Public Health – Seattle & King County, Seattle (98104), Washington, USA
| | - Lea M Starita
- Brotman Baty Institute for Precision Medicine, Seattle (98195), Washington, USA,Department of Genome Sciences, University of Washington, Seattle (98195), Washington, USA
| | - Janet A Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle (98105), Washington, USA
| | - Helen Y Chu
- Alternate Corresponding Author: Helen Y. Chu, MD, MPH, Division of Allergy and Infectious Diseases, University of Washington, 750 Republican Street, Seattle, Washington 98109, Ph: 206-685-8702, E-mail:
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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Dao TL, Hoang VT, Ly TDA, Goumballa N, Gautret P. Epidemiological Investigations of Infectious Diseases among Mobile Populations at the University Hospital Institute Mediterranean Infection in Marseille, France. J Epidemiol Glob Health 2021; 11:271-282. [PMID: 34514760 PMCID: PMC8435867 DOI: 10.2991/jegh.k.210526.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
We review the most recent work conducted by our group on the circulation of infectious agents in mobile populations, including pilgrims participating in the Hajj (Mecca, Saudi Arabia) and the Grand Magal of Touba (Senegal) pilgrimages, homeless people, and medical students participating in an elective abroad. Using a similar epidemiological study design with standardized questionnaires and molecular assays allows comparison of different populations of travelers. The main infectious pathogens and antibiotic resistance genes linked to travel were identified in certain specific populations of travelers, as well as in a group of homeless migrant people in Marseille. The role of several risk factors has also been demonstrated, allowing identifying individuals at increased risk of disease or pathogen carriage on which to base targeted preventive measures. Such results, together with those obtained through international surveillance networks allow better description of the epidemiology of travel-associated infectious diseases.
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Affiliation(s)
- Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
| | - Ndiaw Goumballa
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, France.,IHU-Méditerranée Infection, 19-21 Boulevard Jean, Moulin 13385, Marseille Cedex 05, France
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Mohsenpour A, Bozorgmehr K, Rohleder S, Stratil J, Costa D. SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: Systematic review and meta-analysis. EClinicalMedicine 2021; 38:101032. [PMID: 34316550 PMCID: PMC8298932 DOI: 10.1016/j.eclinm.2021.101032] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) may be at risk for COVID19. We synthesised evidence on SARS-Cov-2 infection, transmission, outcomes of disease, effects of non-pharmaceutical interventions (NPI), and the effectiveness of strategies for infection prevention and control (IPC). METHODS Systematic review of articles, indexed in electronic databases (EMBASE, WHO-Covid19, Web of Science), institutional websites and the Norwegian Institute of Public Health's live map of COVID-19 evidence, and published from December 1st, 2019, to March 3rd, 2021. Empirical papers of any study design addressing Covid-19 and health(-related) outcomes in PEH or shelters' staff were included. (PROSPERO-2020-CRD42020187033). FINDINGS Of 536 publications, 37 studies were included (two modelling, 31 observational, four qualitative studies). Random-effect meta-analysis yields a baseline SARS-Cov-2 prevalence of 2•32% (95% Confidence-Interval, 95%CI=1•30-3•34) in PEH and 1•55% (95%CI=0•79-2•31) in staff. In outbreaks, the pooled prevalence increases to 31•59% (95%CI=20•48-42•71) in PEH and 14•80% (95%CI=10•73-18•87) in staff. Main IPC strategies were universal rapid testing, expansion of non-congregate housing, and in-shelter measures (bed spacing, limited staff rotation, reduction in number of residents). INTERPRETATION 32% of PEH and 15% staff are infected during outbreaks of SARS-Cov-2 in homeless shelters. Most studies were conducted in the USA. No studies were found quantifying health-related outcomes of NPI. Overview and evaluation of IPC strategies for PEH, a better understanding of disease transmission, and reliable data on PEH within Covid-19 notification systems are needed. Qualitative studies may serve to voice PEH and shelter staff experiences, and guide future evaluations and IPC strategies. FUNDING None.
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Affiliation(s)
- Amir Mohsenpour
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.O. Box: 10 01 31, 33501 Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
- Corresponding author at: Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.O. Box: 10 01 31, 33501 Bielefeld, Germany.
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.O. Box: 10 01 31, 33501 Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
| | - Sven Rohleder
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.O. Box: 10 01 31, 33501 Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
| | - Jan Stratil
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.O. Box: 10 01 31, 33501 Bielefeld, Germany
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