Heinrich Fabian, Wong Tsz Lun Ernest, Graf Wiebke, Dost Katharina, Brennecke Anna, Kowalski Veronika, van Rüth Victoria, Iwersen-Bergmann Stefanie, Hajek André, König Hans-Helmut, Renné Thomas, Brehm Thomas T, Pfefferle Susanne, Schulze Zur Wiesch Julian, Dandri Maura, Aepfelbacher Martin, Püschel Klaus, Ondruschka Benjamin, Lütgehetmann Marc, Stallbaum Franziska
Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Sci Rep. 2025 Sep 17;15(1):32571. doi: 10.1038/s41598-025-18552-3.
People experiencing homelessness (PEH) are at risk of contracting and transmitting infectious diseases. Data on PEH blood-transmitted virus prevalence and vaccination coverage is needed to design targeted interventions. A nationwide multicentre cross-sectional study of PEH was conducted. Clinical data were collected through questionnaire-based interviews, and blood samples were tested by serology and qPCR. Latent class analysis (LCA) identified subgroups of PEH, while univariable regressions identified risk factors of viral hepatitis. 643 PEH from four metropolitan areas in Germany were included. LCA revealed national short-term, long-term and international short-term PEH subgroups. The prevalence of anti-HAV-IgG, anti-HBc, anti-HBsAg, anti-HCV, anti-HEV and anti-HIV was 44% (95%CI: 39-48%), 17% (95%CI: 14-21%), 25% (95%CI: 21-29%), 18% (95%CI: 15-22%), 29% (95%CI: 25-33%) and 0.7% (95%CI: 0.2-1.7%), respectively. Active HBV and HCV infection was detected in 1.4% (95%CI: 0.7-2.7%) and 12% (95%CI: 9.6-14%), respectively. Univariable logistic regression revealed PEH with former imprisonment had 13.24 times the odds of active or past HCV infection (95%CI: 6.28-27.90) that individuals without had. This study shows the high acquisition and transmission risks for HCV/HIV among PEH. Low vaccination coverage for HAV/HBV calls for revising vaccine recommendations. High HCV infection risk associated with imprisonment highlights the need to address health disparities faced by incarcerated individuals.
无家可归者（PEH）有感染和传播传染病的风险。需要有关PEH血液传播病毒流行率和疫苗接种覆盖率的数据来设计针对性的干预措施。开展了一项针对PEH的全国性多中心横断面研究。通过基于问卷的访谈收集临床数据，并通过血清学和定量聚合酶链反应检测血样。潜在类别分析（LCA）确定了PEH的亚组，而单变量回归确定了病毒性肝炎的危险因素。纳入了来自德国四个大都市地区的643名PEH。LCA揭示了全国短期、长期和国际短期PEH亚组。抗甲型肝炎病毒IgG、抗乙型肝炎核心抗体、抗乙型肝炎表面抗原、抗丙型肝炎病毒、抗戊型肝炎病毒和抗人类免疫缺陷病毒的流行率分别为44%（95%置信区间：39-48%）、17%（95%置信区间：14-21%）、25%（95%置信区间：21-29%）、18%（95%置信区间：15-22%）、29%（95%置信区间：25-33%）和0.7%（95%置信区间：0.2-1.7%）。分别在1.4%（95%置信区间：0.7-2.7%）和12%（95%置信区间：9.6-14%）的人群中检测到活动性乙型肝炎病毒和丙型肝炎病毒感染。单变量逻辑回归显示，有前科的PEH发生活动性或既往丙型肝炎病毒感染的几率是无前科者的13.24倍（95%置信区间：6.28-27.90）。本研究表明，PEH感染丙型肝炎病毒/人类免疫缺陷病毒的风险很高。甲型肝炎病毒/乙型肝炎病毒疫苗接种覆盖率低，需要修订疫苗接种建议。与监禁相关的高丙型肝炎病毒感染风险凸显了解决被监禁者所面临的健康差距的必要性。
