Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 460-464

Tuberculosis in the Homeless
A Prospective Study

ANDREW R. MOSS, JUDITH A. HAHN, JACQUELINE P. TULSKY, CHARLES L. DALEY, PETER M. SMALL, and PHILLIP C. HOPEWELL

Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco; Medical Service, San Francisco General Hospital, San Francisco; and Department of Medicine, Stanford University Medical Center, Stanford, California

We set out to determine tuberculosis incidence and risk factors in the homeless population in San Francisco. We also examined the transmission of tuberculosis by molecular methods. We followed a cohort of 2,774 of the homeless first seen between 1990 and 1994. There were 25 incident cases during the period 1992 to 1996, or 270 per 100,000 per year (350/100,000 in African Americans, 450/100,000 in other nonwhites, 60/100,000 in whites). Ten cases were persons with seropositive HIV. Independent risk factors for tuberculosis were HIV infection, African American or other nonwhite ethnicity, positive tuberculin skin test (TST) results, age, and education; 60% of the cases had clustered patterns of restriction fragment length polymorphism, thought to represent recent transmission of infection with rapid progression to disease. Seventy-seven percent of African-American cases were clustered, and 88% of HIV-seropositive cases. The high rate of tuberculosis in the homeless was due to recent transmission in those HIV-positive and nonwhite. African Americans and other nonwhites may be at high risk for infection or rapid progression. Control measures in the homeless should include directly observed therapy and incentive approaches, treatment of latent tuberculous infection in those HIV-seropositive, and screening in hotels and shelters.

This article has been cited by other articles:

				L. Flores, L. G. Jarlsberg, E. Y. Kim, D. Osmond, J. Grinsdale, M. Kawamura, E. Desmond, P. C. Hopewell, and M. Kato-Maeda Comparison of Restriction Fragment Length Polymorphism with the Polymorphic Guanine-Cytosine-Rich Sequence and Spoligotyping for Differentiation of Mycobacterium tuberculosis Isolates with Five or Fewer Copies of IS6110 J. Clin. Microbiol., February 1, 2010; 48(2): 575 - 578. [Abstract] [Full Text] [PDF]

				D. P. Holland, G. D. Sanders, C. D. Hamilton, and J. E. Stout Costs and Cost-effectiveness of Four Treatment Regimens for Latent Tuberculosis Infection Am. J. Respir. Crit. Care Med., June 1, 2009; 179(11): 1055 - 1060. [Abstract] [Full Text] [PDF]

				A Story, S Murad, W Roberts, M Verheyen, A C Hayward, and for the London Tuberculosis Nurses Network Tuberculosis in London: the importance of homelessness, problem drug use and prison Thorax, August 1, 2007; 62(8): 667 - 671. [Abstract] [Full Text] [PDF]

				G. de Vries, R. A. H. van Hest, and J. H. Richardus Impact of Mobile Radiographic Screening on Tuberculosis among Drug Users and Homeless Persons Am. J. Respir. Crit. Care Med., July 15, 2007; 176(2): 201 - 207. [Abstract] [Full Text] [PDF]

				S. Patel, A. E. Parsyan, J. Gunn, M. A. Barry, C. Reed, S. Sharnprapai, and C. R. Horsburgh Jr Risk of Progression to Active Tuberculosis Among Foreign-Born Persons With Latent Tuberculosis Chest, June 1, 2007; 131(6): 1811 - 1816. [Abstract] [Full Text] [PDF]

				G. de Vries and R. A. van Hest From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam Eur J Public Health, April 1, 2006; 16(2): 133 - 136. [Abstract] [Full Text] [PDF]

				American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1169 - 1227. [Full Text] [PDF]

				J. Lukacs, V. Tubak, J. Mester, S. David, Z. Bartfai, T. Kubica, S. Niemann, and A. Somoskovi Conventional and Molecular Epidemiology of Tuberculosis in Homeless Patients in Budapest, Hungary J. Clin. Microbiol., December 1, 2004; 42(12): 5931 - 5934. [Abstract] [Full Text] [PDF]

				C. R. Horsburgh Jr. Priorities for the Treatment of Latent Tuberculosis Infection in the United States N. Engl. J. Med., May 13, 2004; 350(20): 2060 - 2067. [Abstract] [Full Text] [PDF]

				American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of Tuberculosis Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 603 - 662. [Full Text] [PDF]

				M. J. TOBIN Tuberculosis, Lung Infections, and Interstitial Lung Disease in AJRCCM 2000 Am. J. Respir. Crit. Care Med., November 15, 2001; 164(10): 1774 - 1788. [Full Text] [PDF]

				T. F. Brewer, S. J. Heymann, S. M. Krumplitsch, M. E. Wilson, G. A. Colditz, and H. V. Fineberg Strategies to Decrease Tuberculosis in US Homeless Populations: A Computer Simulation Model JAMA, August 15, 2001; 286(7): 834 - 842. [Abstract] [Full Text] [PDF]