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Homelessness and Hepatitis A-San Diego County, 2016-2018.
Clin Infect Dis. 2020 06 24; 71(1):14-21.CI

Abstract

BACKGROUND

Hepatitis A is a vaccine-preventable viral disease transmitted by the fecal-oral route. During 2016-2018, the County of San Diego investigated an outbreak of hepatitis A infections primarily among people experiencing homelessness (PEH) to identify risk factors and support control measures. At the time of the outbreak, homelessness was not recognized as an independent risk factor for the disease.

METHODS

We tested the association between homelessness and infection with hepatitis A virus (HAV) using a test-negative study design comparing patients with laboratory-confirmed hepatitis A with control subjects who tested negative for HAV infection. We assessed risk factors for severe hepatitis A disease outcomes, including hospitalization and death, using multivariable logistic regression. We measured the frequency of indications for hepatitis A vaccination according to Advisory Committee on Immunization Practices (ACIP) guidelines.

RESULTS

Among 589 outbreak-associated cases reported, 291 (49%) occurred among PEH. Compared with those who were not homeless, PEH had 3.3 (95% confidence interval [CI], 1.5-7.9) times higher odds of HAV infection, 2.5 (95% CI, 1.7-3.9) times higher odds of hospitalization, and 3.9 (95% CI, 1.1-16.9) times higher odds of death associated with hepatitis A. Among PEH, 212 (73%) patients recorded other ACIP indications for hepatitis A vaccination.

CONCLUSIONS

PEH were at higher risk of infection with HAV and of severe hepatitis A disease outcomes compared with those not experiencing homelessness. Approximately one-fourth of PEH had no other ACIP indication for hepatitis A vaccination. These findings support the recent ACIP recommendation to add homelessness as an indication for hepatitis A vaccination.

Authors+Show Affiliations

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia. County of San Diego Health and Human Services Agency, San Diego, California. Division of Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, San Diego, California.County of San Diego Health and Human Services Agency, San Diego, California.Divisions of Foodborne, Waterborne, and Environmental Diseases, Atlanta, Georgia.Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.County of San Diego Health and Human Services Agency, San Diego, California.County of San Diego Health and Human Services Agency, San Diego, California.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31412358

Citation

Peak, Corey M., et al. "Homelessness and Hepatitis A-San Diego County, 2016-2018." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 71, no. 1, 2020, pp. 14-21.
Peak CM, Stous SS, Healy JM, et al. Homelessness and Hepatitis A-San Diego County, 2016-2018. Clin Infect Dis. 2020;71(1):14-21.
Peak, C. M., Stous, S. S., Healy, J. M., Hofmeister, M. G., Lin, Y., Ramachandran, S., Foster, M. A., Kao, A., & McDonald, E. C. (2020). Homelessness and Hepatitis A-San Diego County, 2016-2018. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 71(1), 14-21. https://doi.org/10.1093/cid/ciz788
Peak CM, et al. Homelessness and Hepatitis A-San Diego County, 2016-2018. Clin Infect Dis. 2020 06 24;71(1):14-21. PubMed PMID: 31412358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homelessness and Hepatitis A-San Diego County, 2016-2018. AU - Peak,Corey M, AU - Stous,Sarah S, AU - Healy,Jessica M, AU - Hofmeister,Megan G, AU - Lin,Yulin, AU - Ramachandran,Sumathi, AU - Foster,Monique A, AU - Kao,Annie, AU - McDonald,Eric C, PY - 2019/02/08/received PY - 2019/08/13/accepted PY - 2019/8/15/pubmed PY - 2021/3/13/medline PY - 2019/8/15/entrez KW - hepatitis A KW - hepatitis A vaccine KW - homelessness SP - 14 EP - 21 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 71 IS - 1 N2 - BACKGROUND: Hepatitis A is a vaccine-preventable viral disease transmitted by the fecal-oral route. During 2016-2018, the County of San Diego investigated an outbreak of hepatitis A infections primarily among people experiencing homelessness (PEH) to identify risk factors and support control measures. At the time of the outbreak, homelessness was not recognized as an independent risk factor for the disease. METHODS: We tested the association between homelessness and infection with hepatitis A virus (HAV) using a test-negative study design comparing patients with laboratory-confirmed hepatitis A with control subjects who tested negative for HAV infection. We assessed risk factors for severe hepatitis A disease outcomes, including hospitalization and death, using multivariable logistic regression. We measured the frequency of indications for hepatitis A vaccination according to Advisory Committee on Immunization Practices (ACIP) guidelines. RESULTS: Among 589 outbreak-associated cases reported, 291 (49%) occurred among PEH. Compared with those who were not homeless, PEH had 3.3 (95% confidence interval [CI], 1.5-7.9) times higher odds of HAV infection, 2.5 (95% CI, 1.7-3.9) times higher odds of hospitalization, and 3.9 (95% CI, 1.1-16.9) times higher odds of death associated with hepatitis A. Among PEH, 212 (73%) patients recorded other ACIP indications for hepatitis A vaccination. CONCLUSIONS: PEH were at higher risk of infection with HAV and of severe hepatitis A disease outcomes compared with those not experiencing homelessness. Approximately one-fourth of PEH had no other ACIP indication for hepatitis A vaccination. These findings support the recent ACIP recommendation to add homelessness as an indication for hepatitis A vaccination. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31412358/Homelessness_and_Hepatitis_A_San_Diego_County_2016_2018_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz788 DB - PRIME DP - Unbound Medicine ER -