Pneumococcal infections and homelessness


homelessness; invasive pneumococcal diseases, Streptococcus pneumoniae, pneumococcal vaccination, real-time polymerase chain reaction.


Objectif. To assess the prevalence of pneumococcal nasopharyngeal carriage, the role of potential risk factors, and vaccination against invasive pneumococcal diseases (IPD) among sheltered homeless persons (HP) in Marseille, France.

Methods. In 2015–2018, we enrolled 571 sheltered homeless males and 54 non-homeless controls. Streptococcus pneumoniae was directly searched form nasal/pharyngeal samples using PCR.

Results. The HPs were predominantly middle-aged, mostly migrants originating from African countries. Pneumococcal vaccination rate was low (3.1%). The overall pneumococcal carriage rate was 13.0% and was significantly higher in HPs (15.3% in 2018) than in controls (3.7%), with p=0.033. Among HPs, being aged ≥65 years (OR=1.97, p=0.048), living in one specific shelter (OR=1.80, p=0.028), and presenting respiratory symptoms and signs at the time of enrolment (OR=2.55, p<10-4) were independent factors associated with pneumococcal carriage.

Conclusion. Pneumococcal vaccination should be systematically considered for sheltered HPs in France, as has been the case in Canada since 2008.


[1] Lemay JA, Ricketson LJ, Zwicker L, Kellner JD. Homelessness in Adults with Invasive Pneumococcal Disease (IPD) in Calgary, Canada. Open Forum Infect Dis 2019;6(10):ofz362.
[2] Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Invasive pneumococcal disease: Still lots to learn and a need for standardized data collection instruments. Can Respir J 2017:2397429.
[3] Schillberg E, Isaac M, Deng X, Peirano G, Wylie JL, Van Caeseele P, Pillai DR, Sinnock H, Mahmud SM. Outbreak of invasive Streptococcus pneumoniae serotype 12F among a marginalized inner-city population in Winnipeg, Canada, 2009-2011. Clin Infect Dis 2014;59(5):651-7.
[4] Tyrrell GJ, Lovgren M, Ibrahim Q, Garg S, Chui L, Boone TJ, Mangan C, Patrick DM, Hoang L, Horsman GB, Van Caeseele P, Marrie TJ. Epidemic of invasive pneumococcal disease, western Canada, 2005-2009. Emerg Infect Dis 2012;18(5):733-40.
[5] Mercat A, Nguyen J, Dautzenberg B. An outbreak of pneumococcal pneumonia in two men's shelters. Chest 1991 Jan;99(1):147-51.
[6] McKee G, Choi A, Madill C, Marriott J, Kibsey P, Hoyano D. Outbreak of invasive Streptococcus pneumoniae among an inner-city population in Victoria, British Columbia, 2016-2017. Can Commun Dis Rep 2018;44:317-323.
[7] Beall B, Walker H, Tran T, Li Z, Varghese J, McGee L, Li Y, Metcalf BJ, Gierke R, Mosites E, Chochua S, Pilishvili T. Upsurge of conjugate vaccine serotype 4 invasive pneumococcal disease clusters among adults experiencing homelessness in California, Colorado, and New Mexico. J Infect Dis 2020: jiaa501.
[8] Mosites E, Zulz T, Bruden D, Nolen L, Frick A, Castrodale L, McLaughlin J, Van Beneden C, Hennessy TW, Bruce MG. Risk for invasive streptococcal infections among adults experiencing homelessness, Anchorage, Alaska, USA, 2002–2015. Emerg Infect Dis 2019; 25(10):1911-1918.
[9]. Shariatzadeh MR, Huang JQ, Tyrrell GJ, Johnson MM, Marrie TJ. Bacteremic pneumococcal pneumonia: a prospective study in Edmonton and neighboring municipalities. Medicine (Baltimore). 2005; 84(3):147-161.
[10]. Plevneshi A, Svoboda T, Armstrong I, Tyrrell GJ, Miranda A, Green K, Low D, McGeer A; Toronto Invasive Bacterial Diseases Network. Population-based surveillance for invasive pneumococcal disease in homeless adults in Toronto. PLoS One. 2009;4(9):e7255.
[11] Ly TDA, Edouard S, Badiaga S, Tissot-Dupont H, Hoang VT, Pommier de Santi V, Brouqui P, Raoult D, Gautret P. Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015-2017: cross sectional 1-day surveys. Clin Microbiol Infect 2019;25(2):249.e1-249.e6.
[12] Ministère des Solidarités et de la Santé. Calendrier des vaccinations et recommandations vaccinales 2019. Available at: ; 2019 [accessed 23 September 2020].
[13] Ly TDA, Dao TL, Hoang VT, Braunstein D, Brouqui P, Lagier JC, Parola P, Gautret P. Pattern of infections in French and migrant homeless hospitalised at Marseille infectious disease units, France: A retrospective study, 2017-2018. Travel Med Infect Dis 2020;36:101768.
[14] Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019; 68(46):1069-1075. Erratum in: MMWR Morb Mortal Wkly Rep 2019; 68(5152):1195.
[15] Ly TDA, Touré Y, Calloix C, Badiaga S, Raoult D, Tissot-Dupont H, Brouqui P, Gautret P. Changing Demographics and Prevalence of Body Lice among Homeless Persons, Marseille, France. Emerg Infect Dis 2017; 23 (11):1894-1897.
[16] Ly TDA, Hoang VT, Goumballa N, Louni M, Canard N, Dao TL, Medkour H, Borg A, Bardy K, Esteves-Vieira V, Filosa V, Davoust B, Mediannikov O, Fournier PE, Raoult D, Gautret P. Screening of SARS-CoV-2 among homeless people, asylum seekers and other people living in precarious conditions in Marseille, France, March April 2020. Preprint,
[17] Dao TL, Canard N, Hoang VT, Ly TDA, Drali T, Ninove L, Fenollar F, Raoult D, Parola P, Marty P, Gautret P. Risk factors for symptoms of infection and microbial carriage among French medical students abroad. Int J Infect Dis 2020: S1201-9712(20)30704-9.