{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:20:50Z","timestamp":1790076050045,"version":"4.0.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T00:00:00Z","timestamp":1565913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013739","name":"Pfizer Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013739","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Homelessness is uncommon but is frequently a characteristic in adults with invasive pneumococcal disease (IPD). In Calgary, homeless persons comprise approximately 0.2% of the population. We evaluated the relationship of homelessness and IPD in Calgary.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Demographic, clinical, and microbiologic data were collected by the Calgary Streptococcus pneumoniae Epidemiology Research (CASPER) team through prospective, population-based surveillance of all IPD cases. Here, we report on cases in adults (\u226518 years) from 2000 to 2016.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1729 IPD cases, 321 (18.8%) occurred in homeless persons. Compared with nonhomeless persons, homeless persons were younger, more often male, smokers, alcohol abusers, illegal drug users, and had a primary diagnosis of pneumonia. In multivariable models of outcomes, homeless persons had lower odds of being admitted to the ICU (odds ratio [OR], 0.7; P = .02) and lower odds of death (OR, 0.6; P = .146). IPD caused by serotypes 4, 5, or 8, which have caused outbreaks in Calgary, was more common in homeless persons (54.4% vs 21.0%; P &amp;lt; .001). In addition, regardless of homeless status, persons with IPD caused by serotypes 4, 5, or 8 had lower odds of ICU admission and mortality (OR, 0.7; P = .017; and OR, 0.4; P = .004; respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Homelessness is overrepresented in IPD cases in Calgary, despite most homeless persons having fewer risk factors than the overall population of persons with IPD. Most cases are caused by serotypes in both the 23-valent polysaccharide vaccine and the 13-valent conjugate vaccine. Thus, enhanced efforts are needed to deliver both vaccines to this vulnerable population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofz362","type":"journal-article","created":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T17:34:04Z","timestamp":1565976844000},"source":"Crossref","is-referenced-by-count":27,"title":["Homelessness in Adults With Invasive Pneumococcal Disease in Calgary, Canada"],"prefix":"10.1093","volume":"6","author":[{"given":"Julie-Anne","family":"Lemay","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah J","family":"Ricketson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Zwicker","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D","family":"Kellner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary, Canada"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Canada"},{"name":"Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada"},{"name":"Alberta Children\u2019s Hospital Research Institute, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,8,16]]},"reference":[{"key":"2020081004470430300_CIT0001","doi-asserted-by":"crossref","first-page":"e28547","DOI":"10.1371\/journal.pone.0028547","article-title":"Community-based outbreaks in vulnerable populations of invasive infections caused by Streptococcus pneumoniae serotypes 5 and 8 in Calgary, Canada","volume":"6","author":"Vanderkooi","year":"2011","journal-title":"PLoS One"},{"key":"2020081004470430300_CIT0002","doi-asserted-by":"publisher","DOI":"10.1177\/0885066617728895","article-title":"Outcomes of critically ill patients who have serotype 5 invasive pneumococcal disease [published online ahead of print January 1, 2017]","author":"Zurawska","journal-title":"J Intensive Care Med"},{"key":"2020081004470430300_CIT0003","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/INF.0b013e3181658c5c","article-title":"Effects of routine infant vaccination with the 7-valent pneumococcal conjugate vaccine on nasopharyngeal colonization with Streptococcus pneumoniae in children in Calgary, Canada","volume":"27","author":"Kellner","year":"2008","journal-title":"Pediatr Infect Dis J"},{"key":"2020081004470430300_CIT0004","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/INF.0000000000000267","article-title":"Trends in asymptomatic nasopharyngeal colonization with Streptococcus pneumoniae after introduction of the 13-valent pneumococcal conjugate vaccine in Calgary, Canada","volume":"33","author":"Ricketson","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"2020081004470430300_CIT0005","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1093\/cid\/ciw175","article-title":"Influence of childhood pneumococcal conjugate vaccines on invasive pneumococcal disease in adults with underlying comorbidities in Calgary, Alberta (2000\u20132013)","volume":"62","author":"Cabaj","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2020081004470430300_CIT0006","volume-title":"Pneumococcal polysaccharide vaccine biological page.","author":"Alberta Health Services","year":"2018"},{"key":"2020081004470430300_CIT0007","volume-title":"Pneumococcal 13-valent conjugate vaccine biological page","author":"Alberta Health Services","year":"2018"},{"key":"2020081004470430300_CIT0008","volume-title":"Canadian definition of homelessness","author":"Gaetz","year":"2012"},{"key":"2020081004470430300_CIT0009","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1007\/BF03403700","article-title":"Homelessness and health in Canada: research lessons and priorities","volume":"96","author":"Frankish","year":"2005","journal-title":"Can J Public Health"},{"key":"2020081004470430300_CIT0010","volume-title":"2018 Alberta point-in-time homeless count","author":"Turner Strategies","year":"2018"},{"key":"2020081004470430300_CIT0011","first-page":"1\u201312","article-title":"Statement on the recommended use of pneumococcal 23-valent polysaccharide vaccine in homeless persons and injection drug users. 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