#Zoonotic and #Vector-Borne #Infections Among #Urban #Homeless and Marginalized People in the #USA and #Europe, 1990–2014 (Vector Borne Zoo Dis., abstract)

[Source: Vector Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Vector-Borne and Zoonotic Diseases 

Zoonotic and Vector-Borne Infections Among Urban Homeless and Marginalized People in the United States and Europe, 1990–2014

To cite this article: Leibler Jessica H., Zakhour Christine M., Gadhoke Preety, and Gaeta Jessie M.. Vector-Borne and Zoonotic Diseases. May 2016, ahead of print. doi:10.1089/vbz.2015.1863.

Online Ahead of Print: May 9, 2016

Author information: 1Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts. 2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. 3College of Pharmacy and Health Sciences, St. Johns University, Queens, New York. 4Boston Health Care for the Homeless Program, Boston, Massachusetts. 5Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.

Address correspondence to: Jessica H. Leibler, Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T430W, Boston, MA 02118, E-mail: jleibler@bu.edu




In high-income countries, homeless individuals in urban areas often live in crowded conditions with limited sanitation and personal hygiene. The environment of homelessness in high-income countries may result in intensified exposure to ectoparasites and urban wildlife, which can transmit infections. To date, there have been no systematic evaluations of the published literature to assess vector-borne and zoonotic disease risk to these populations.


The primary objectives of this study were to identify diversity, prevalence, and risk factors for vector-borne and zoonotic infections among people experiencing homelessness and extreme poverty in urban areas of high-income countries.


We conducted a systematic review and narrative synthesis of published epidemiologic studies of zoonotic and vector-borne infections among urban homeless and very poor people in the United States and Europe from 1990 to 2014.


Thirty-one observational studies and 14 case studies were identified (n = 45). Seroprevalence to the human louse-borne pathogen Bartonella quintana (seroprevalence range: 0–37.5%) was identified most frequently, with clinical disease specifically observed among HIV-positive individuals. Seropositivity to Bartonella henselae (range: 0–10.3%) and Rickettsia akari (range: 0–16.2%) was noted in multiple studies. Serological evidence of exposure to Rickettsia typhi, Rickettsia prowazekii, Bartonella elizabethae, West Nile virus, Borellia recurrentis, lymphocytic choriomeningitis virus, Wohlfartiimonas chitiniclastica, Seoul hantavirus (SEOV), and Leptospira species was also identified in published studies, with SEOV associated with chronic renal disease later in life. HIV infection, injection drug use, and heavy drinking were noted across multiple studies as risk factors for infection with vector-borne and zoonotic pathogens.


B. quintana was the most frequently reported vector-borne infection identified in our article. Delousing efforts and active surveillance among HIV-positive individuals, who are at elevated risk of complication from B. quintana infection, are advised to reduce morbidity. Given documented exposure to rodent-borne zoonoses among urban homeless and marginalized people, reducing human contact with rodents remains an important public health priority.

Keywords: Research; Abstracts; Zoonoses; USA; Europe.