Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015–2017: cross sectional 1-day surveys
Authors: V T Hoang
S Badiaga
T D A Ly
D Raoult
P Gautret
S Edouard
H Tissot-Dupont
P Brouqui
V Pommier de Santi
Journal: Clinical Microbiology and Infection (2019)
Discipline: IMMUNOLOGY
Keywords: Homeless; Quantitative polymerase chain reaction; Quantitative reverse transcription–polymerase chain reaction; Respiratory pathogen carriage; Respiratory symptoms and signs.
Affiliations: Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France., French Military Centre for Epidemiology and Public Health Marseille, France., Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France. Electronic address: .

Abstract:  Objectives: To assess risk factors for respiratory tract infection symptoms and signs in sheltered homeless people in Marseille during the winter season, including pathogen carriage. Methods: Data on 479 male participants within two shelters who completed questionnaires and a total of 950 nasal and pharyngeal samples were collected during the winters of 2015-2017. Respiratory pathogen carriage including seven viruses and four bacteria was assessed by quantitative PCR. Results: The homeless population was characterized by a majority of individuals of North African origin (300/479, 62.6%) with a relatively high prevalence of chronic homelessness (175/465, 37.6%). We found a high prevalence of respiratory symptoms and signs (168/476, 35.3%), a very high prevalence of bacterial carriage (313/477, 65.6%), especially Haemophilus influenzae (280/477, 58.7%), and a lower prevalence of virus carriage (51/473, 10.8%) with human rhinovirus being the most frequent (25/473, 5.3%). Differences were observed between the microbial communities of the nose and throat. Duration of homelessness (odds ratio (OR) 1.77, p 0.017), chronic respiratory diseases (OR 5.27, p &lt;0.0001) and visiting countries of origin for migrants (OR 1.68, p 0.035) were identified as independent risk factors for respiratory symptoms and signs. A strong association between virus (OR 2.40, p 0.012) or Streptococcus pneumoniae (OR 2.32, p 0.014) carriage and respiratory symptoms and signs was also found. Conclusions: These findings allowed identification of the individuals at higher risk for contracting respiratory tract infections to better target preventive measures aimed at limiting the transmission of these diseases in this setting. 

Retracted: No

PubPeer comments:
 In this study, homeless persons in Marseille were recruited from shelters, examined, and nasal and pharyngeal swabs were obtained. I have a question about the IRB approval for this study, since homeless persons might be considered to be a  vulnerable population (i.e., vulnerable to coercion), similar to veterans or prisoners in the US, although IRB rules might differ per country. Surprisingly, the IRB approval number listed in this paper (2010-A01406-33) is used for at least 17 studies, including this one. Although all of them involve homeless persons recruited from Marseille shelters, the studies themselves vary in terms of study protocols and treatment sample collection. The studies vary from collecting lice, treating subjects with drug-impregnated underwear, filling out questionnaires, medical exams, to nasal and pharyngeal sampling, skin swabbing, blood draw, rectal samples, sputum collection, and chest X rays. Moreover, the studies were performed from 2011 to 2020, spanning almost 10 years. Would the authors be willing to share the original 2010 ethical approval application here? Did they get approval for all these different studies spanning 10 years, in one single application? There is also confusion about which institution or ethical board approved the study. Some papers state that the study was approved by  our institutional review board , suggesting that this was a number referring to IRB approval by the Aix-Marseille Universitu00e9 and or Institut Hospitalo-Universitaire Mu00e9diterranu00e9e Infection, both listed as author affiliations. But in other papers, the IRB approval number appears to be an ANSM RCB authorization ID, as per  Informed consent was obtained from these subjects, and the study was approved by the u2018u2018Comitu00e9 de Protection des Personnes Sud Mediterranu00e9eu2019u2019 on January, 12, 2011 (ID RCB: 2010-A01406-33) , e.g. as mentioned in PLoS ONE 8(2): e58088. Either way, it would be of interest to take away any concern whether studies on this vulnerable populations were all performed within the original IRB approval scope. Here is the list of 17 papers that all appear to share the same ethical approval number: * Rezak Drali et al. - Journal of Clinical Microbiology (2012) p. 2229u20132233 - DOI: 10.1128 JCM.00808-12 * Rezak Drali et al. - PLoS ONE 8(2): e58088 (2013) - DOI: 10.1371 journal.pone.0058088 * Samir Benkouiten et al. - JAMA Dermatol. 2014;150(3):273-279 (2014) - DOI: 10.1001 jamadermatol.2013.6398 * Rezak Drali et al - Infection, Genetics and Evolution 39 (2016) 225u2013231 - DOI: 10.1016 j.meegid.2016.02.008 * Tran Duc Anh Ly et al. - Emerging Infectious Diseases (2017) - DOI: 10.3201 eid2311.170516 * Tran Duc Anh Ly et al. - Clinical Microbiology and Infection 25 (2019) 249.e1e249.e6 - DOI: 10.1016 j.cmi.2018.04.032 * Tran Duc Anh Ly et al. - Front. Cell. Infect. Microbiol. 9:86 (2019) - DOI: 10.3389 fcimb.2019.00086 * Tran Duc Anh Ly et al. - Journal of Epidemiology and Global Health (2019) - DOI: 10.2991 jegh.k.190510.001 * Tran Duc Anh Ly et al. - Infection and Drug Resistance 2019:12 1139u20131151 - DOI: 10.2147 IDR.S202048 * Nadia Amanzougaghene et al. - Parasites Vectors (2020) 13:177 - DOI: 10.1186 s13071-020-04036-y * Tran Duc Anh Ly et al. - European Journal of Clinical Microbiology Infectious Diseases (2020) - DOI: 10.1007 s10096-020-03889-6 * Tran Duc Anh Ly et al. - Travel Medicine and Infectious Disease 36 (2020) 101768 - DOI: 10.1016 j.tmaid.2020.101768 * Tran Duc Anh Ly et al. - Vector-Borne and Zoonotic Diseases (2020) - DOI: 10.1089 vbz.2019.2603 * Tran Duc Anh Ly et al. - Acta Microbiologica et Immunologica Hungarica (2021) - DOI: 10.1556 030.2021.01346 * Tran Duc Anh Ly et al. - Journal of Epidemiology and Global Health (2021) - DOI: 10.2991 jegh.k.201009.001 * Tran Duc Anh Ly et al. - Journal of Infection Volume 82, Issue 1, January 2021, Pages 60-66 - DOI: 10.1016 j.jinf.2020.11.026 * Tran Duc Anh Ly et al. - European Journal of Clinical Microbiology Infectious Diseases (2021) - DOI: 10.1007 s10096-020-04127-9 ,