Homeless Shelter Viruses and Vaccines
Respiratory Virus Surveillance in Homeless Shelters
People experiencing homelessness are at high risk of complications related to viral respiratory infection due to underlying conditions. Homeless shelter conditions additionally facilitate the transmission of respiratory viruses due to congregate sleeping environments and transiency of clients, yet little is known about their burden. We aimed to characterize the prevalence, associated risk factors, and transmission dynamics of influenza and other respiratory viruses through active shelter-based surveillance between January 2019 and May 2021. Nasal swabs and sociodemographic/illness surveys were collected from both symptomatic and asymptomatic participants and tested for 27 respiratory pathogens using RT-PCR. This surveillance was conducted across a demographically diverse selection of congregate shelters serving people experiencing homelessness.
Randomized Clinical Trial of On-Site Testing and Treatment for Influenza
Prior to the pandemic, we designed and led a randomized clinical trial of on-site testing and treatment for influenza in homeless shelters, which can be used as a model for early diagnosis and treatment for viral infections. in congregate settings such as nursing facilities, prisons, or refugee camps. This work has also led to a strong partnership with the Special Populations Unit at CDC, national recognition in respiratory viruses in homeless populations, and the receipt of grants to understand barriers to vaccine uptake in this population.
SARS CoV-2 Testing Surveillance
Upon the introduction of SARS-CoV-2 to Washington State in early 2020, we initiated a dual strategy of standard surveillance and outbreak testing for COVID-19 at a total of 23 shelters in partnership with Public Health Seattle-King County and homeless service site management. Shelter staff and residents were repeatedly tested cross-sectionally through the end of the study period (May 2021) which has uniquely allowed our team to describe temporal trends and associated risk factors in a vulnerable population. Whole genomic sequencing of SARS-CoV-2 samples has also provided valuable insight into transmission dynamics within a congregate space.
Predictors of Vaccine Hesitancy
In February 2021, the CDC reached out to our research team about interest in the development and assessment of COVID-19 mitigation strategies, especially related to vaccine distribution, targeted specifically for people experiencing homelessness. This led to the development of a mixed methods study aimed at describing shelter residents’ experiences and perceptions of the barriers and facilitators of COVID-19 testing or vaccination. This included inquiries regarding the operational and logistical details of COVID-19 testing services or vaccination (accessibility, efficiency, efficacy), perceived personal risk/benefits of vaccination, and an attempt to elicit information about vaccine confidence and confidence in the healthcare system within a pandemic context.
Publications
Boonyaratanakornkit J, et al. Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA. Emerg Infect Dis. 2019 Jul.
Rogers JH, et al. Characteristics of COVID-19 in Homeless Shelters : A Community-Based Surveillance Study. Ann Intern Med. 2021 Jan.
Newman KL, et al. Point-of-care molecular testing and antiviral treatment of influenza in residents of homeless shelters in Seattle, WA: study protocol for a stepped-wedge cluster-randomized controlled trial. Trials. 2020 Nov 23.
Casto AM, et al. Phylogenomics of SARS-CoV-2 in Emergency Shelters for People Experiencing Homelessness. J Infect Dis. 2022 Jan 29.
Rogers JH, et al. Trends in COVID-19 vaccination intent and factors associated with deliberation and reluctance among adult homeless shelter residents and staff, 1 November 2020 to 28 February 2021 - King County, Washington. Vaccine. 2022 Jan 3.
Tobolowsky FA, et al. COVID-19 Outbreak Among Three Affiliated Homeless Service Sites - King County, Washington, 2020. MMWR Morb Mortal Wkly Rep. 2020 May 1.
Chow EJ, et al. The Clinical and Genomic Epidemiology of Rhinovirus in Homeless Shelters-King County, Washington. J Infect Dis. 2022 Jun 24.
Chow EJ, et al. Human Parainfluenza Virus in Homeless Shelters before and during the COVID-19 Pandemic, Washington, USA. Emerg Infect Dis. 2022 Sep 23.
Chow EJ, et al. The clinical and genomic epidemiology of seasonal human coronaviruses in congregate homeless shelter settings: A repeated cross-sectional study. Lancet Reg Health Am. 2022 Nov.
Cox SN, et al. Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021. Vaccine X. 2022 Dec.
Rogers JH, Hawes SE, Wolf CR, Hughes JP, Englund JA, Starita LM, Chu HY. Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study. Front Public Health. 2023.
Meehan AA, Cox SN, Thuo NB, Rogers JH, Link AC, Martinez MA, Lo NK, Manns BJ, Rolfes MA, Chow EJ, Chu HY, Mosites E, Al Achkar M. Previous Health Care Experiences' Influence on Health Care Perceptions Among Residents of Six Homeless Shelters in Seattle, Washington, July-October 2021. J Patient Cent Res Rev. 2023 Summer.
McCulloch DJ, Rogers JH, Wang Y, Chow EJ, Link AC, Wolf CR, Uyeki TM, Rolfes MA, Mosites E, Sereewit J, Duchin JS, Sugg NK, Greninger AL, Boeckh MJ, Englund JA, Shendure J, Hughes JP, Starita LM, Roychoudhury P, Chu HY. Respiratory syncytial virus and other respiratory virus infections in residents of homeless shelters - King County, Washington, 2019-2021. Influenza Other Respir Viruses. 2023 Jun.
Cox SN, Scott EM, Rogers JH, Chow EJ, Wasse JK, Carone M, Hughes JP, Chu HY. Burden of long COVID among adults experiencing sheltered homelessness: a longitudinal cohort study in King County, WA between September 2020-April 2022. BMC Public Health. 2023 Jun 6.
Rogers JH, Cox SN, Link AC, Nwanne G, Han PD, Pfau B, Chow EJ, Wolf CR, Boeckh M, Hughes JP, Halloran ME, Uyeki TM, Shim MM, Duchin J, Englund JA, Mosites E, Rolfes MA, Starita LA, Chu HY. Incidence of SARS-CoV-2 infection and associated risk factors among staff and residents at homeless shelters in King County, Washington: an active surveillance study. Epidemiol Infect. 2023 Jul 10.
Media
https://newsroom.uw.edu/news/lessons-coronavirus-surveillance-homeless-shelters
Funding
Gates Foundation, U.S. Center for Disease Control and Prevention