Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA

Jim Boonyaratanakornkit; Seda Ekici; Amalia Magaret; Kathryn Gustafson; Emily Scott; Micaela Haglund; Jane Kuypers; Ronald Pergamit; John Lynch; Helen Y. Chu


Emerging Infectious Diseases. 2019;25(7):1408-1411. 

In This Article

Abstract and Introduction


Homelessness has not previously been identified as a risk factor for respiratory syncytial virus (RSV) infection. We conducted an observational study at an urban safety-net hospital in Washington, USA, during 2012–2017. Hospitalized adults with RSV were more likely to be homeless, and several clinical outcome measures were worse with RSV than with influenza.


Respiratory syncytial virus (RSV) is increasingly recognized as a major pathogen in adults and shows a disease burden comparable to that for influenza.[1] No vaccine is currently available. However, several vaccine candidates against RSV are in clinical trials, and the elderly, those with chronic lung disease, infants, and immunocompromised persons remain priority target populations for prevention efforts.[2,3]

Rates of homelessness are increasing in major urban centers because of lack of affordable housing and slower wage growth.[4] Homeless persons experience higher rates of illness and death compared with the general population, partly because of infectious diseases from lack of access to sanitation, crowding in shelters, untreated chronic medical conditions, and higher rates of mental health issues and substance use.[5] Studies have described local outbreaks of rhinovirus and influenza in homeless shelters.[6] Identification of homeless persons as an at-risk population for severe RSV disease might guide prioritization strategies for RSV vaccines and therapeutics as they become available. We aimed to evaluate risk factors and clinical outcomes of adults hospitalized with RSV infections versus those with influenza in an urban medical center serving a region that had high rates of homelessness.