Factors associated with the presence of anti-Leptospira spp. antibodies in persons experiencing homelessness in Brazil

Haroldo Greca Junior¹Cassiana Dahlke Machado¹Louise Bach Kmetiuk²Danilo Alves de França³Nassarah Jabur Lot Rodrigues³Anahi Chechia Do Couto¹Helio Langoni³Gustavo Monti⁴Alexander Welker Biondo^1*

• ¹Federal University of Paraná, Curitiba, Paraná, Brazil
• ²Prefeitura Municipal de Curitiba, Curitiba, Paraná, Brazil
• ³São Paulo State University, São Paulo, São Paulo, Brazil
• ⁴Wageningen University and Research, Wageningen, Netherlands

Homelessness has been considered one of the most vulnerable situations worldwide, alongside people private of liberty (incarceration) and country displacement (refugees). Structural inequality and exposure to diseases such as leptospirosis may be aggravated by individual issues including drug addiction, mental disorders and improper healthcare. The present study reported that persons experiencing homelessness living in two major Brazilian cities have been highly exposed to leptospirosis, which may indicate exposure nationwide and demand urgent action on surveillance, control and prevention. Location, condom use, and flea infestations were identified as statistically significant associated risk factors for exposure. The presence of multiple Leptospira spp. serovars may indicate bacterial diversity, even in urban settings. The results herein found for persons experiencing homelessness were not a surprise, as Brazil has been historically recognized as an endemic country for leptospirosis, with 3,810 leptospirosis cases on average per year and the majority living in densely populated urban areas. Multidisciplinary efforts and integrated policies may be crucial to mitigate leptospirosis and other infectious diseases in persons experiencing homelessness, as social neglection may impact on their fundamental rights to dignity and access to personal health.