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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-one observational studies and 14 case studies were identified (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200945). Seroprevalence to the human louse-borne pathogen\n                      <jats:italic toggle=\"yes\">Bartonella quintana<\/jats:italic>\n                      (seroprevalence range: 0\u201337.5%) was identified most frequently, with clinical disease specifically observed among HIV-positive individuals. Seropositivity to\n                      <jats:italic toggle=\"yes\">Bartonella henselae<\/jats:italic>\n                      (range: 0\u201310.3%) and\n                      <jats:italic toggle=\"yes\">Rickettsia akari<\/jats:italic>\n                      (range: 0\u201316.2%) was noted in multiple studies. Serological evidence of exposure to\n                      <jats:italic toggle=\"yes\">Rickettsia typhi<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Rickettsia prowazekii<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Bartonella elizabethae<\/jats:italic>\n                      , West Nile virus,\n                      <jats:italic toggle=\"yes\">Borellia recurrentis<\/jats:italic>\n                      , lymphocytic choriomeningitis virus,\n                      <jats:italic toggle=\"yes\">Wohlfartiimonas chitiniclastica<\/jats:italic>\n                      , Seoul hantavirus (SEOV), and\n                      <jats:italic toggle=\"yes\">Leptospira<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">B. quintana<\/jats:italic>\n                      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\n                      <jats:italic toggle=\"yes\">B. quintana<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/vbz.2015.1863","type":"journal-article","created":{"date-parts":[[2016,5,9]],"date-time":"2016-05-09T11:56:11Z","timestamp":1462794971000},"page":"435-444","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":88,"title":["Zoonotic and Vector-Borne Infections Among Urban Homeless and Marginalized People in the United States and Europe, 1990\u20132014"],"prefix":"10.1177","volume":"16","author":[{"given":"Jessica H.","family":"Leibler","sequence":"first","affiliation":[{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Zakhour","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preety","family":"Gadhoke","sequence":"additional","affiliation":[{"name":"St. Johns University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie M.","family":"Gaeta","sequence":"additional","affiliation":[{"name":"Boston Health Care for the Homeless Program, Boston, Massachusetts."},{"name":"Department of Medicine, Boston University School of Medicine, Boston, Massachusetts."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,7,1]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cimid.2011.09.008"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03778.x"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02183-14"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(08)70150-6"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(12)70177-9"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tree.2006.11.001"},{"key":"e_1_3_3_8_1","first-page":"474","article-title":"Culture-negative endocarditis: Contribution of Bartonella infections","volume":"77","author":"Breathnach AS","year":"1997","unstructured":"Breathnach AS, , Hoare JM, , Eykyn SJ. 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