Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

Shannan N Rich^{1

2}, Ann Carpenter^{1

3}, Bree Dell⁴, Rachel Henderson⁵, Sydney Adams^{3

6}, Nicolette Bestul³, Christopher Grano⁷, Briana Sprague⁷, Josh Leopold⁸, Elizabeth K Schiffman⁸, Andrea Lomeli⁹, Hassan Zadeh⁹, Jemma Alarcón^{1

10}, Umme-Aiman Halai¹⁰, Yoon-Sung Nam^{1

11}, Leah Seifu^{1

12}, Sally Slavinski¹³, David Crum¹⁴, Emily Mosites¹⁵, Johanna S Salzer³, Alison F Hinckley², David W McCormick³, Grace E Marx²

Affiliations

¹ Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
³ Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ Communicable Disease Epidemiology & Immunization Section, Public Health - Seattle & King County, Seattle, Washington State, USA.
⁵ University of Colorado Anschutz Medical Campus at Colorado State University, Fort Collins, Colorado, USA.
⁶ Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA.
⁷ Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA.
⁸ Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA.
⁹ Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA.
¹⁰ Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA.
¹¹ Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹² Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹³ Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹⁴ Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, Maryland, USA.
¹⁵ Office of the Director, Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

PMID: 38514461
DOI: 10.1111/zph.13125

Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

Shannan N Rich et al. Zoonoses Public Health. 2024 Sep.

. 2024 Sep;71(6):642-652.

doi: 10.1111/zph.13125. Epub 2024 Mar 21.

Authors

Affiliations

¹ Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
³ Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ Communicable Disease Epidemiology & Immunization Section, Public Health - Seattle & King County, Seattle, Washington State, USA.
⁵ University of Colorado Anschutz Medical Campus at Colorado State University, Fort Collins, Colorado, USA.
⁶ Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA.
⁷ Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA.
⁸ Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA.
⁹ Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA.
¹⁰ Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA.
¹¹ Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹² Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹³ Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York City, New York, USA.
¹⁴ Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, Maryland, USA.
¹⁵ Office of the Director, Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

PMID: 38514461
DOI: 10.1111/zph.13125

Abstract

Background and aims: Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases.

Methods and results: Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared.

Conclusions: Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.

Keywords: Bartonella quintana; Rickettsia typhi; body lice; flea‐borne diseases; louse‐borne diseases; murine typhus; people experiencing homelessness.

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References

REFERENCES

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Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

Affiliations

Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous