Key points
- People experiencing homelessness should be vaccinated against hepatitis A and hepatitis B.
- CDC recommends one-time hepatitis B and hepatitis C testing of all adults and periodic testing for people with risk factors.
Risks
Certain groups, including people experiencing homelessness, have a higher risk of contracting viral hepatitis.
Definition of homelessness
Recognizing the individual's unstable living arrangements is critical to the definition of homelessness. According to the United States Department of Health and Human Services, a person is experiencing homelessness if:
- They lack housing, including if their primary residence during the night is a supervised public or private facility (for example, a shelter) and/or if they are a resident in transitional housing.
- They are without permanent housing and live on the streets; stay in a shelter, mission, single-room occupancy facility, abandoned building, or vehicle; or are in any other unstable or nonpermanent situation.
- They are "doubled up," a term that refers to a situation where individuals are unable to maintain housing and are forced to stay with a series of friends and/or extended family members.
- They have just been released from the hospital with no stable housing to which they can return.
- They are to be released from a prison or correctional setting with no stable housing to which they can return. CDC has developed recommendations to consider for release planning including linking the person to prevention and care services.
Hepatitis A
Hepatitis A virus (HAV) infection is associated with poor hygiene, contact with people who are infected with the virus, and contaminated food/water. Congregate living conditions, both within and outside of shelters, increase the risk for disease transmission among people experiencing homelessness, which can result in outbreaks. In the US, there is an ongoing widespread person-to-person transmission of hepatitis A.
Hepatitis B
Hepatitis B virus (HBV) is a bloodborne pathogen. It is highly infectious and transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is uninfected.
People who have been in jail or prison have a higher risk of infection, along with people who use drugs (PWUD) or share needles, syringes, or other types of drug equipment.
Hepatitis C
Hepatitis C virus (HCV) is also a bloodborne pathogen. Homelessness isn't by itself a risk factor for hepatitis C, but individuals experiencing homelessness may fall into other groups that CDC recommends for periodic testing, such as PWUD. Offering screening and testing to people in settings such as homeless shelters could help identify people who might have HCV infection and can be cured with treatment.
Preventing viral hepatitis
Hepatitis A
For hepatitis A, vaccination is the most reliable protection from HAV infection and consists of a 2-dose schedule (or a 3-dose schedule when the combined hepatitis A and hepatitis B vaccine is administered). CDC recommends vaccination for people experiencing homelessness.
Hepatitis B
For hepatitis B, vaccination is the most effective means of preventing transmission among people at risk for infection. CDC recommends vaccination for people experiencing homelessness.
Furthermore, CDC published updated recommendations for hepatitis B screening and testing in 2023 that are complementary to the 2022 Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for hepatitis B.
The updated recommendations include hepatitis B screening for all adults once in their lifetime, and hepatitis B vaccination for all adults aged 19-59 years.
Implementing these recommendations in settings such as homeless shelters where services are provided to people at risk for HBV infection can be an effective strategy for preventing HBV in people who would otherwise not seek out care. This might include:
- People with hepatitis C
- People with chronic liver disease
- PWUD
- People with human immunodeficiency virus (HIV)
Learn more about the updated recommendations for hepatitis B screening and testing.
Hepatitis C
For hepatitis C, there is no vaccine, but curative treatment is available. CDC recommends one-time hepatitis C testing of all adults 18 and older. CDC continues to recommend that people with risk factors, including PWUD, be tested regularly and provided with treatment in a timely manner.
Learn more about clinical screening and testing for hepatitis C.
Communication resources
Posters, digital tools, and social media
The following resources can be printed or shared via websites, email signatures, social media, digital advertising, or other online platforms to encourage hepatitis A vaccination of people experiencing homelessness.
Fact sheets
Clinical resources
These resources can help clinicians and public health professionals reach people experiencing homelessness. Use these materials to educate people about viral hepatitis risks, prevention, and treatment.
CDC resources
Additional resources
- National Health Care for the Homeless Council. Understanding homelessness: frequently asked questions. Nashville, TN: National Health Care for the Homeless Council.
- Cornell U Law School. Health Centers, 42 U.S. Code. Sect. 254b. Legal Information Institute.
- Health Resources and Services Administration, Bureau of Primary Health Care. Health center program compliance manual — Glossary: 330(h) homeless population. Rockville, MD: Health Resources and Services Administration.
- Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR Morb Mortal Wkly Rep 2019;68:153–156. DOI: http://dx.doi.org/10.15585/mmwr.mm6806a6.
- Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023. MMWR Recomm Rep 2023;72(No. RR-1):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7201a1.
- Weng MK, Doshani M, Khan MA, et al. Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:477–483. DOI: http://dx.doi.org/10.15585/mmwr.mm7113a1.
- Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1–17. DOI: http://dx.doi.org/10.15585/mmwr.rr6902a1.