Shigellosis Among People Experiencing Homelessness

Shigella bacteria can spread easily, especially in environments where there is crowding or access to clean water and toilets is limited. Because of this, people experiencing homelessness are at high risk for Shigella infection when shigellosis is spreading in the community. This includes people who are unsheltered (sleeping outside or in places not meant for people to live) or sheltered and living in group settings.

People experiencing homelessness are more likely to get a Shigella infection for various reasons. They may have pre-existing conditions that can weaken their immune system, such as HIV, hepatitis, or tuberculosis, which can put them at higher risk of severe shigellosis. They also may face challenges in their living situations that increase the risk for disease transmission, which can result in outbreaks. These may include:

• Exposure to contaminated food and water
• Overcrowding in shelters
• Limited or no access to hygiene and sanitation services

Addressing these risk factors will help prevent Shigella outbreaks among people experiencing homelessness.

Investigating Shigellosis Outbreaks Among People Experiencing Homelessness

Investigating these outbreaks requires tailored strategies to collect information and implement prevention measures. Specific considerations to keep in mind during an investigation include:

• People experiencing homelessness may move between encampment areas and shelters. Check with outreach workers if you aren’t sure where to find someone.
• Some people experiencing homelessness may not want to be interviewed. Make sure to approach people with an understanding of their situation and with respect to the other priorities they might have.
• People experiencing homelessness may have difficulty getting medical care. Work with healthcare services to help them connect for follow-up care as needed.

Prevention Strategies

Health departments can work with local governments, health care providers, and homeless services to adopt strategies to prevent shigellosis outbreaks:

• Increase availability of handwashing sinks in homeless shelters and encampments or other locations where people experiencing homelessness spend time
• Increase accessibility of public restrooms in communities with large numbers of people experiencing homelessness
• Ensure that public restrooms and portable sanitation services are clean and well-maintained
• Distribute educational resources about personal and sexual hygiene in homeless sites or shelters
• Provide communication and preparedness resources promoting handwashing behavior change, food safety, and safe water practices
• Share information about Shigella infections by providing fact sheets and other communication materials.