Infectious Diseases in the Homeless

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[Ted Pestorius] Hello, I’m Ted Pestorius speaking today with Dr. Marian McDonald, the Associate Director for Minority and Women’s Health at CDC’s National Center for Preparedness, Detection, and Control of Infectious Diseases. We’re here to talk about an article in the September 2008 issue of Emerging Infectious Diseases on infectious diseases in the homeless. So Marian, tell us what type of diseases are the homeless most susceptible to?

[Dr. Marian McDonald] There’s a range of infectious diseases that the homeless are susceptible to, so it’s appropriate to look at this topic in the EID journal. The homeless population is vulnerable to many diseases, including HIV, hepatitis, and tuberculosis. But often, people don’t think of the other issues related to hygiene and housing that the homeless face, such as lice and scabies.

[Ted Pestorius] That’s a good point. But why is this population particularly vulnerable to these diseases?

[Dr. Marian McDonald] Well by definition, the homeless are a population affected by poverty. The homeless face extreme economic conditions, such as job loss, eviction, or foreclosure, which have led to their becoming homeless. Many people who become homeless already have compromised general or mental health and compromised immune systems. They’re often facing high levels of stress and trauma, in addition to nutritional deficits. Homeless people often sleep outdoors, in vehicles and abandoned buildings, or other places that are not meant for human habitation, and they don’t have access to daily means of personal hygiene, which affects their ability to take regular basic precautions, like hand washing.

[Ted Pestorius] Hmm. So what type of interventions does the EID article look at?

[Dr. Marian McDonald] The study looks at several different interventions. Those that were found to be the best were immunizations against hepatitis, influenza, strep, and diphtheria; chest x-rays for TB screening in shelters, along with Directly Observed Therapy for TB; tailored education; improvement of personal hygiene, clothing, and bedding; treatment for the effects of lice and scabies; distribution of free condoms; and syringe and needle prescription programs. The article points out that for such efforts to be successful, a comprehensive national public health prevention program for the homeless is needed.

[Ted Pestorius] And what’s the public health importance of this study?

[Dr. Marian McDonald] There are an estimated 100 million homeless people worldwide today, and this number is likely to grow. In the U.S., we have many businesses downsizing or relocating, along with a national housing crisis. These developments are leading to more and more people becoming homeless. Globally, climate change is requiring relocation of large groups of people, often resulting in homelessness. The homeless are a growing population, and the growth is not going to stop any time soon. This article provides many needed insights and can help guide public health policy to protect the health of the homeless.

[Ted Pestorius] Our discussion today with Dr. Marian McDonald was prompted by an article in the September 2008 issue of Emerging Infectious Diseases. These articles, and others on emerging bacterial and viral diseases, can be read online at www.cdc.gov/eidwww.cdc.gov/eid. And you can submit your comments on this interview to eideditor@cdc.gov. That’s eideditor—one word—@cdc.gov. For Emerging Infectious Diseases, I’m Ted Pestorius.

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