Tuberculosis and Homelessness: Why Shelters Raise the Risk and How to Prevent Spread

Tuberculosis (TB) is a serious health threat, especially for people experiencing homelessness. It is hard to find, treat and control — above all in places like homeless shelters, where people live and work close together. Shelter staff can help stop TB germs spreading, and CDC has resources for homeless service providers.

Why it matters

People experiencing homelessness often lack ready access to the medical care that finds inactive TB or active TB disease early.

• Untreated inactive TB can turn into active disease at any time.
• Active TB disease can spread to the people someone spends time with every day — and untreated, it can be fatal.

So preventing, finding and treating active TB early stops the spread and keeps people safe.

In 2023, among people 15 or older with TB disease:

Who is more likely to be exposed

People who live or used to live in large group settings where TB is more common, such as homeless shelters, and people who work in them. More: Exposure to Tuberculosis.

Why TB spreads in shelters

Health. Some people who live or work in shelters take certain medicines or have health conditions that raise their risk of active disease once infected.

• People experiencing homelessness are more likely to use substances — excess alcohol, non-injecting and injecting drug use — which is a TB risk factor and a barrier to diagnosis and treatment.
• People with weakened immune systems are at very high risk of active disease once infected; for them, treating inactive TB is especially important.

The building. Shelters are places where people live in close physical proximity, and may have poor air flow, shared airspace and overcrowding — all of which make diseases, TB among them, more likely to spread. More: how TB spreads.

Moving between shelters. People may move from shelter to shelter, which can make it hard to finish treatment — especially across jurisdictions — and hard for TB programs to find people who were exposed but have since left. Providers can work with state and local TB programs and partners so people can continue and complete treatment.

Prevention and control in shelters

Good measures protect residents, staff and the wider community:

• a TB screening program;
• treatment for inactive TB and active TB disease;
• a thorough, efficient contact investigation whenever a case of active TB disease is diagnosed.

Shelters should plan how they will find and treat active TB to prevent outbreaks, and work closely with their local or state TB program, which staff can contact for information.

What CDC is doing

Ending TB means keeping up and strengthening diagnosis and treatment, especially in groups at higher risk. For people experiencing homelessness, CDC:

• works with national and public health organizations to improve screening, diagnosis and treatment;
• works with health care agencies that serve them to improve TB control.

Resources

• Curry International TB Center: Homelessness and TB and tools for homeless service providers
• Global Tuberculosis Institute at Rutgers: TB Among the Homeless: Dealing with Unique Challenges
• CDC's booklet Staying on Track with Tuberculosis Medicine, to help people complete treatment

Sources

Based on "TB Risk and People Experiencing Homelessness," Centers for Disease Control and Prevention, October 29, 2024; a work of the United States government in the public domain. The source's stock photograph is not reproduced.