A respiratory illness surveillance pilot project among people experiencing homelessness – Anchorage, Alaska, 2023–2024

People experiencing homelessness (PEH) are at increased risk of respiratory infections and adverse health outcomes, including complications, hospitalization, and death, compared to people not experiencing homelessness. In this paper, we describe the implementation of a respiratory illness surveillance pilot among PEH in Anchorage, Alaska designed to inform public health action by local implementing partners and document lessons learned. Between February 9, 2023, and February 29, 2024, we recruited participants from two shelters and one recurring service outreach pop-up event near encampments. Participants completed a brief interview and provided an anterior nasal specimen. Samples were tested for the presence of SARS-CoV-2, influenza A/B viruses, and RSV A/B. We enrolled 296 participants and collected 475 nasal specimens. Of the 475 nasal specimens collected, we detected SARS-CoV-2 (6.1%), influenza A (1.9%), RSV A (0.8%), and RSV B (1.3%). Several considerations that could affect implementation success related to recruitment, data quality, and specimen collection were noted. Conducting respiratory surveillance among PEH is feasible through partnering with local faith-based nonprofit organizations. Ensuring representation of PEH in surveillance data and understanding baseline respiratory infection trends can inform guidance to better protect the health of PEH in future pandemics.