Bartonella quintana in body lice and head lice from homeless persons, San Francisco, California, USA.

Bartonella quintana is a bacterium that causes trench fever in humans. Past reports have shown Bartonella spp. infections in homeless populations in San Francisco, California, USA. The California Department of Public Health in collaboration with San Francisco Project Homeless Connect initiated a program in 2007 to collect lice from the homeless to test for B. quintana and to educate the homeless and their caregivers on prevention and control of louse-borne disease. During 2007-2008, 33.3% of body lice-infested persons and 25% of head lice-infested persons had lice pools infected with B. quintana strain Fuller. Further work is needed to examine how homeless persons acquire lice and determine the risk for illness to persons infested with B. quintana-infected lice.

Preventing and controlling emerging and reemerging transmissible diseases in the homeless.

Homelessness is an increasing public health problem. Because of poor living conditions and limited access to healthcare systems, homeless persons are exposed to many communicable infections. We summarize the intervention measures reported to be efficient for the control and the prevention of common transmissible infections among homeless populations. Evidence suggests that appropriate street- or shelter-based interventions for targeted populations are the most efficient methods. Depending on the populations targeted, these interventions may include education, free condom distribution, syringe and needle prescription programs, chest radiography screening for tuberculosis, directly observed therapy for tuberculosis treatment, improvement of personal clothing and bedding hygiene, and widespread use of ivermectin for scabies and body louse infestation. Systematic vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diphtheria is strongly recommended. National public health programs specific to homeless populations are required.

Body lice as tools for diagnosis and surveillance of reemerging diseases.

Body lice are vectors of three bacteria which cause human disease: Rickettsia prowazekii, the agent of epidemic typhus; Bartonella quintana, the agent of trench fever; and Borrelia recurrentis, the agent of relapsing fever. A recrudescence of body lice is being observed as the numbers of individuals living under social conditions which predispose individuals to infestation have increased. Because this phenomenon may lead to the reemergence of infections transmitted by body lice, we aimed to assess the occurrence and prevalence of the three agents described above in more than 600 body lice collected from infested individuals in the African countries of Congo, Zimbabwe, and Burundi, in France, in Russia, and in Peru. The presence of the three bacteria in each louse was determined by specific PCR amplification, and the identities of the organisms detected were confirmed by determination of the nucleotide base sequences of the amplification products. Using this approach, we were able to confirm the presence of R. prowazekii in lice collected from refugees in Burundi, among whom typhus was epidemic, and the presence of B. quintana in lice collected from all locations except the Congo. B. recurrentis was never found. Molecular approaches are convenient tools for the detection and identification of bacterial DNA in body lice and for the epidemiological study of louse-borne bacteria from countries where no medical and biological laboratory facilities are available.

[The epidemiology of trench fever: a pilot study in homeless people in Marseilles]. / Epidémiologie de la fièvre des tranchées: une enquête pilote auprès des "sans domicile fixe" marseillais.

Trench fever, cause by Bartonella quintana, disappeared decades ago. Between 1992 and 1994 about 20 cases were reported in industrialized countries [6, 7]. Some of these cases were associated with HIV infection [5], but most affected the homeless. The epidemiology of B. quintana is unknown in Europe, but infection and transmission are favoured by poor housing and hygiene. This paper describes the results of a seroprevalence survey among the homeless living in Marseille. The eight major non-profit organizations caring for the homeless in the city participated for the four winter months. Four of these organizations also provide health care. Each subject who came to be housed for more than one day were asked to complete a questionnaire and give a small blood sample by micropuncture. They were clearly informed about the aims of the research and were allowed to refuse participation freely. All blood samples were tested by the WHO collaborative center for ricketssiae using a previously tested and validated immunofluorescence technique. The subjects were scored positive if the IgG titer was above 1/100. Two hundred and twenty one subjects agreed to participate in the study. Most were of French origin (51.4%) and 40% under 40 years old. The seroprevalence was 1.8% (IC 95%: 0.05-3.55). None of the four positive subjects presented symptoms and clinical examination was normal. All four were over 40 years old; two were of French origin, 1 from Algeria and 1 from the Comoro Islands. One had an IgG titer above 1/3, 200, possibly reflecting recent contamination and/or severe infection. Statistical analysis revealed no significant association between seropositivity and housing or hygiene conditions. No socio-demographic data are available about the homeless in Marseille and indeed, there is no list of such individuals. It is therefore not possible to estimate the representativity of our sample. Nevertheless, we show that the homeless include infected individuals. Physicians who care for such subjects should prescribe B. quintana serological investigations, and organizations that take in these people should implement preventive action and health education programs. Any such policy must be designed so as to be acceptable to homeless people. This work should also encourage public health professionals to investigate more extensively infectious diseases among the homeless.

[The status of epidemiological surveillance in rickettsioses in Ukraine]. / Pro stan epidemiolohichnoho nahliadu pry ryketsiozakh v Ukraïni.

A multi-annual study of rickettsiosis in the Ukraine is presented which included Brill's disease, Q-fever, Volyn fever. The status of epidemiological surveillance is outlined. Ways of perfection of the surveillance system are described.