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The European Journal of Public Health Advance Access originally published online on January 22, 2009
The European Journal of Public Health 2009 19(2):157-160; doi:10.1093/eurpub/ckn142
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Inequalities in Health

Contribution of a shelter-based survey for screening respiratory diseases in the homeless

Sékéné Badiaga1,2, Hervé Richet1,3,4, Patricia Azas5, Christine Zandotti3,4, Françoise Rey5, Rémi Charrel3,4, El-hadi Benabdelkader5, Michel Drancourt1,3,4, Didier Raoult1,3,4 and Philippe Brouqui1,3,6

1 URMITE CNRS-IRD UMR 6236, Faculté de médecine, Marseille, France
2 Service d’Accueil des Urgences, Hôpital Nord, Marseille, France
3 Pôle des Maladies Infectieuses, Hôpitaux de Marseille, France
4 Fédération de Bactériologie-Virologie-Hygiène, Hôpital de la Timone, Marseille, France
5 Centre de lutte anti-tuberculeuse, Conseil Général 13, Marseille, France
6 Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Marseille, France

Correspondence: Philippe Brouqui, URMITE CNRS-IRD UMR 6236, Faculté de médecine, 27 bd Jean Moulin 13385, Marseille Cedex 5, France, tel: +33 491 32 43 75, fax: +33 491 38 77 72, e-mail: philippe.brouqui{at}univmed.fr

Received February 11, 2008 , accepted December 22, 2008

Background: The homeless are at very high risk for both respiratory diseases and poor access to health care delivery systems. The aim of this study was to assess the contribution of a shelter-based survey to identify respiratory diseases in the homeless population in Marseilles, in order to further develop preventive interventions. Methods: A prevalence survey of respiratory diseases was conducted in two homeless shelters in Marseilles, in February 2005. A multidisciplinary team including infectious diseases specialists, lung specialists, residents, nurses, physiotherapists and X-ray technicians visited the two shelters. Interview, physical examination, sputum sampling for Mycobacterium tuberculosis detection, nasal swabs for virus detection and chest X-rays were performed in shelters. Chest X-rays were subsequently analysed by a pneumonologist and subjects found to have radiological abnormalities were hospitalized for further investigations. Results: Of the 221 homeless persons enrolled, 110/221 (50%) had at least one respiratory manifestations. Chest X-rays were abnormal in 14 persons. Active tuberculosis was diagnosed in two, influenza in two, respiratory syncytial virus infection in two, acute pneumonia in one, asthma in two, lung cancer in one, acute bronchitis in 23, chronic bronchitis in 42, and exacerbation of chronic obstructive pulmonary disease in 22 persons, respectively. Conclusion: Our shelter-based survey, including clinical evaluation and chest radiographic screening, shows that this approach can be useful to control and prevent respiratory diseases among the homeless. However, further studies are necessary to determine the magnitude of influenza in the homeless, the impact of influenza immunization and optimal frequency of interventions in shelters.

Keywords: homelessness, influenza, respiratory diseases, shelter-based survey, tuberculosis


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