Homelessness and the Response to Emerging Infectious Disease Outbreaks: Lessons from SARS
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During the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, the potential introduction of SARS into the homeless population was a serious concern. Although no homeless individual in Toronto contracted SARS, the outbreak highlighted the need to develop an outbreak preparedness plan that accounts for unique issues related to homeless people. We conducted key informant interviews with homeless service providers and public health officials (n = 17) and identified challenges specific to the homeless population in the areas of communication, infection control, isolation and quarantine, and resource allocation. Planning for future outbreaks should take into account the need to (1) develop systems that enable rapid two-way communication between public health officials and homeless service providers, (2) ensure that homeless service providers have access to infection control supplies and staff training, (3) prepare for possible homeless shelter closures due to staff shortages or high attack rates among clients, and (4) plan for where and how clinically ill homeless individuals will be isolated and treated. The Toronto SARS experience provided insights that are relevant to response planning for future outbreaks in cities with substantial numbers of homeless individuals.
- Burt M, Aron LY, Lee E, Valente J. Helping America’s Homeless: Emergency Shelter or Affordable Housing?. Washington DC, USA: Urban Institute Press; 2001.
- Los Angeles Homeless Services Authority. 2005 Greater Los Angeles Homeless Count. Available at: http://homelesscount.lahsa.org/index.htm. Accessed on February 6, 2008.
- NYC Department of Homeless Services. Available at: http://www.nyc.gov/html/dhs/html/statistics/statistics.shtml. Accessed on February 6, 2008.
- Hwang SW. Homelessness and health. CMAJ Can Med Assoc J. 2001;164(2):229–233.
- City of Toronto. 2006 Toronto Street Needs Assessment. Available at: http://www.toronto.ca/housing/streetneeds.htm. Accessed on February 6, 2008.
- Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis. 2001;1(2):77–84. CrossRef
- Centers for Disease Control and Prevention (CDC). Tuberculosis transmission in a homeless shelter population—New York, 2000–2003. Morb Mort Wkly Rep. 2005;54(6):149–152.
- Kong PM, Tapy J, Calixto P, et al. Skin-test screening and tuberculosis transmission among the homeless. Emerg Infect Dis. 2002;8(11):1280–1284.
- McElroy PD, Southwick KL, Fortenberry ER, et al. Outbreak of tuberculosis among homeless persons coinfected with human immunodeficiency virus. Clin Infect Dis. 2003;36(10):1305–1312. CrossRef
- Bucher SJ, Brickner PW, Vincent RL. Influenzalike illness among homeless persons. Emerg Infect Dis. 2006;12(7):1162–1163.
- World Health Organization, Department of Communicable Disease Surveillance and Response (CSR). A Framework for Global Outbreak Alert and Response. Available at: http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_CSR_2000_2/en/. Accessed on February 6, 2008.
- Svoboda T, Henry B, Shulman L, et al. Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto. N Engl J Med. 2004;350(23):2352–2361. CrossRef
- Pang X, Zhu Z, Xu F, et al. Evaluation of control measures implemented in the severe acute respiratory syndrome outbreak in Beijing, 2003. JAMA. 2003;290(24):3215–3221, Dec 24. CrossRef
- Gostin LO, Bayer R, Fairchild AL. Ethical and legal challenges posed by severe acute respiratory syndrome:implications for the control of severe infectious disease threats. JAMA. 2003;290(24):3229–3237, Dec 24. CrossRef
- Toronto Public Health. Toronto Pandemic Influenza Plan. Available at: http://www.toronto.ca/health/pandemicflu/index.htm. Accessed on February 6, 2008.
- Heymann DL (Ed.). Control of Communicable Diseases Manual, 18th Edition. Washington DC: American Public Health Association 2004.
- Homelessness and the Response to Emerging Infectious Disease Outbreaks: Lessons from SARS
Journal of Urban Health
Volume 85, Issue 3 , pp 402-410
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Contact tracing
- Disease outbreaks
- Homeless persons
- Patient isolation
- Severe acute respiratory syndrome.
- Author Affiliations
- 1. Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- 2. Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada
- 3. Wasatch Homeless Health Care, Inc., Salt Lake City, UT, USA
- 4. Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
- 5. Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada