P-1329. Invasive Streptococcal Infections in People Experiencing Homelessness in Metro Atlanta — Fulton, DeKalb, and Cobb County, Georgia, 2010–2022

Abstract Background People experiencing homelessness (PEH) are disproportionately affected by infectious diseases compared to people who are housed (non-PEH). In the western U.S., 9–25% of invasive pneumococcal disease (IPD) and group A Streptococcus (IGAS) cases are among PEH; disparities in IPD and IGAS by housing status are not well-documented in other regions. Methods Hospitalized IPD and IGAS cases among residents of 3 metro Atlanta counties (Fulton, DeKalb, & Cobb) ≥18 years occurring during 2010–2022 and their housing status at diagnosis were ascertained from the CDC-funded Georgia Emerging Infections Program. Recurrent cases ≤12 months apart were excluded. During 2010–2018, homelessness was defined by medical record documentation or residence in a shelter, mission, or medical respite. In 2019, the definition expanded to "unstable housing," which included transitional and single-room occupancy housing. Person-level case characteristics by housing status were calculated. Annual age-adjusted incidence per 100,000 population by housing status and incidence rate ratios with 95% confidence intervals were estimated using Poisson regression. Point-in-Time counts (PEH) and 2020 US Census data (non-PEH) were used as population denominators. Results During 2010–2022, 2,202 IPD cases in 2,119 people and 989 IGAS cases in 981 people were identified. Among people with IPD and IGAS, 88 (4%) and 55 (6%) were PEH, respectively (Tables 1–2). IPD and IGAS incidence rates were higher among PEH than non-PEH (Table 3). Among PEH with IPD, 65 (74%) were men and 81 (92%) were < 65 years (vs. 1019 [50%] and 1320 [65%] in non-PEH). Among PEH with IGAS, 40 (73%) were men and 52 (95%) were < 65 years (vs. 473 [51%] and 658 [71%] in non-PEH). PEH with IPD or IGAS were more likely to lack insurance. Both IPD and IGAS incidence among PEH increased before and after the homeless definition change; among non-PEH, incidence decreased (IPD) or was stable (IGAS) (Fig 1). Conclusion The rate of IPD and GAS cases was higher among PEH than non-PEH and increased during 2010–2022. IPD and IGAS cases among PEH occurred more frequently in men and people < 65 years compared to non-PEH. Disparities in IPD and IGAS incidence by housing status exist within metro Atlanta and may be increasing. PEH should be prioritized in IPD and IGAS prevention efforts. Disclosures All Authors: No reported disclosures