ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Homelessness and Hepatitis A-San Diego County, 2016-2018.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 3 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies.The Journal of infectious diseases · 2024Pooled it
- Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Pooled it
- Strategies to improve vaccination rates in people who are homeless: A systematic review.Vaccine · 2022Pooled it
- Considering water, sanitation, and hygiene as a valuable component of harm reduction.Harm reduction journal · 2026Review
- Hepatitis A among people experiencing homelessness: a case series, Curitiba, Paraná State, Brazil, 2023-2024.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2026Article
- Evolving trends in hepatitis A epidemiology: Shifting patterns, emerging risks, and future strategies.World journal of virology · 2025Review
- Influence of substance use on rising hepatitis A hospitalizations in the United States: A decade-long comparative study.World journal of virology · 2025Article
- Development of a novel bivalent vaccine candidate against hepatitis A virus and rotavirus using reverse vaccinology and immunoinformatics.Journal of virus eradication · 2025Article
- Evolving Characteristics of Decedents With Hepatitis A Listed as a Cause of Death, United States, 2011-2021.Journal of viral hepatitis · 2024Article
- Detection ofmSphere · 2024Article
- Immunity against measles, mumps, rubella, and varicella among homeless individuals in Germany - A nationwide multi-center cross-sectional study.Frontiers in public health · 2024Article
- Shigellosis outbreak among persons experiencing homelessness-San Diego County, California, October-December 2021.Epidemiology and infection · 2023Article
- Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review.Vaccines · 2023Review
- Widespread Community Transmission of Hepatitis A Virus Following an Outbreak at a Local Restaurant - Virginia, September 2021-September 2022.MMWR. Morbidity and mortality weekly report · 2023Article
- Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2023Review
- Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers' attitudes and practices.Human vaccines & immunotherapeutics · 2022Article
- Development and Evaluation of a Molecular Hepatitis A Virus Assay for Serum and Stool Specimens.Viruses · 2022Article
- Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters.PloS one · 2022Article
- Application of the Frailty Framework among Vulnerable Populations to Hospitalization Outcomes of Individuals Experiencing Homelessness in Long Beach, California.Journal of social distress and the homeless · 2022Article
- Heterogeneity in Jail Nursing Medical Intake Forms: A Content Analysis.Journal of correctional health care : the official journal of the National Commission on Correctional Health Care · 2021Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundHepatitis 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.
methodsWe 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.
resultsAmong 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.
conclusionsPEH 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.