To the editor, In the USA, homeless persons sleeping on the street, outdoors in vehicles or in abandoned buildings are considered at high risk of hepatitis A (as the result of exposure to unhygienic environments) [1]. Previous epidemiological surveys carried out among infant and adult homeless persons in the USA, Brazil, Canada have reported the total (including IgG) anti-HAV seroprevalence ranging from 4.7% to 69.7% [2] and anti-HAV IgG seroprevalence ranging from 6.3% to 53% [3,4]. The highest rates were observed among those reporting injected drug use, having sexual partner(s) with a history of unspecified hepatitis, or originating from a country with a high HAV prevalence, among men having sex with men (MSM) [2]. Several studies described outbreaks of acute hepatitis A in cities in the UK, the Netherlands, Czech Republic and the USA in populations consisting of between 15.1%—78.0% homeless persons; and outbreak-related hepatitis A deaths ranged between 0%—4.8% [2]. In the USA, the adult immunisation schedule [5], updated annually by the Advisory Committee on Immunization Practices, has recommended HAV vaccination for all homeless individuals aged >1 year since October 2018 [1]. In this article, we aimed to assess the prevalence of anti-HAV IgG antibodies and related risk factors among homeless persons living in shelters in Marseille, France between 2002 and 2015.
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