{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:20:45Z","timestamp":1790076045702,"version":"4.0.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis A is a vaccine-preventable viral disease transmitted by the fecal-oral route. During 2016\u20132018, the County of San Diego investigated an outbreak of hepatitis A infections primarily among people experiencing homelessness (PEH) to identify risk factors and support control measures. At the time of the outbreak, homelessness was not recognized as an independent risk factor for the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We tested the association between homelessness and infection with hepatitis A virus (HAV) using a test-negative study design comparing patients with laboratory-confirmed hepatitis A with control subjects who tested negative for HAV infection. We assessed risk factors for severe hepatitis A disease outcomes, including hospitalization and death, using multivariable logistic regression. We measured the frequency of indications for hepatitis A vaccination according to Advisory Committee on Immunization Practices (ACIP) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 589 outbreak-associated cases reported, 291 (49%) occurred among PEH. Compared with those who were not homeless, PEH had 3.3 (95% confidence interval [CI], 1.5\u20137.9) times higher odds of HAV infection, 2.5 (95% CI, 1.7\u20133.9) times higher odds of hospitalization, and 3.9 (95% CI, 1.1\u201316.9) times higher odds of death associated with hepatitis A. Among PEH, 212 (73%) patients recorded other ACIP indications for hepatitis A vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PEH were at higher risk of infection with HAV and of severe hepatitis A disease outcomes compared with those not experiencing homelessness. Approximately one-fourth of PEH had no other ACIP indication for hepatitis A vaccination. These findings support the recent ACIP recommendation to add homelessness as an indication for hepatitis A vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciz788","type":"journal-article","created":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T07:26:10Z","timestamp":1565681170000},"page":"14-21","source":"Crossref","is-referenced-by-count":52,"title":["Homelessness and Hepatitis A\u2014San Diego County, 2016\u20132018"],"prefix":"10.1093","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6150-5318","authenticated-orcid":false,"given":"Corey M","family":"Peak","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"County of San Diego Health and Human Services Agency, San Diego, California"},{"name":"Division of Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah S","family":"Stous","sequence":"first","affiliation":[{"name":"County of San Diego Health and Human Services Agency, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica M","family":"Healy","sequence":"first","affiliation":[{"name":"Divisions of Foodborne, Waterborne, and Environmental Diseases, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan G","family":"Hofmeister","sequence":"first","affiliation":[{"name":"Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulin","family":"Lin","sequence":"first","affiliation":[{"name":"Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumathi","family":"Ramachandran","sequence":"first","affiliation":[{"name":"Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique A","family":"Foster","sequence":"first","affiliation":[{"name":"Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Kao","sequence":"first","affiliation":[{"name":"County of San Diego Health and Human Services Agency, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C","family":"McDonald","sequence":"first","affiliation":[{"name":"County of San Diego Health and Human Services Agency, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,8,15]]},"reference":[{"key":"2020062404335178400_CIT0001"},{"key":"2020062404335178400_CIT0002","volume-title":"San Diego County Annual Communicable Disease Report","author":"County of San Diego Health and Human Services Agency","year":"2016"},{"key":"2020062404335178400_CIT0003","volume-title":"Hepatitis A virus outbreak associated with homelessness, drug use in San Diego County","author":"County of San Diego Health and Human Services Agency","year":"2017"},{"key":"2020062404335178400_CIT0004","first-page":"1","article-title":"Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"55","author":"Centers for Disease Control and Prevention","year":"2006","journal-title":"Morb Mortal Wkly Rep"},{"key":"2020062404335178400_CIT0005","first-page":"261","article-title":"WHO 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