Knowledge and practices related to louse‐ and flea‐borne diseases among staff providing services to people experiencing homelessness in the United States

• Published in: Zoonoses and public health 2024-09, Vol.71 (6), p.642-652
• Main Authors: Rich, Shannan N., Carpenter, Ann, Dell, Bree, Henderson, Rachel, Adams, Sydney, Bestul, Nicolette, Grano, Christopher, Sprague, Briana, Leopold, Josh, Schiffman, Elizabeth K., Lomeli, Andrea, Zadeh, Hassan, Alarcón, Jemma, Halai, Umme‐Aiman, Nam, Yoon‐Sung, Seifu, Leah, Slavinski, Sally, Crum, David, Mosites, Emily, Salzer, Johanna S., Hinckley, Alison F., McCormick, David W., Marx, Grace E.
• Format: Article
• Language: English
• Subjects: Adult; Animals; Bartonella quintana; body lice; California; Colorado; Disease control; Disease prevention; Disease transmission; Female; Flea Infestations - epidemiology; Flea Infestations - veterinary; flea‐borne diseases; Georgia; Health Knowledge, Attitudes, Practice; Homeless people; Homelessness; Humans; Ill-Housed Persons; Infectious diseases; Insect Vectors - microbiology; Insect Vectors - parasitology; Knowledge management; Lice; Lice Infestations - epidemiology; Lice Infestations - prevention & control; louse‐borne diseases; Male; Maryland; Minnesota; Murine typhus; New York; outreach; people; people experiencing homelessness; Prevention; Public health; Rickettsia typhi; Siphonaptera; Siphonaptera - microbiology; Surveys and Questionnaires; Typhus; United States - epidemiology; Vector-borne diseases; Vectors; Vectors (Biology); zoonoses
• ISSN: 1863-1959; 1863-2378; 1863-2378
• DOI: 10.1111/zph.13125

Background and Aims Louse‐borne Bartonella quintana infection and flea‐borne murine typhus are two potentially serious vector‐borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse‐ and flea‐borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. Methods and Results Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. Conclusions Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse‐ and flea‐borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.