Outbreak control in congregate living settings: results of a scoping review

Background

As a precursor to developing an evidence-based guideline, we conducted a scoping review (DOI: 10.17605/OSF.IO/RWKN9) to identify and describe evidence on public health measures to control outbreaks of infectious diseases in specific congregate settings.

Methods

We searched MEDLINE, Scopus, and the Cochrane Library for empirical literature (January 2000–November 2025) in English, French, or German. Studies had to report an outbreak and related public health measures in OECD countries, in settings defined by the German Infection Protection Act, section 36(1) items 3.-5.: (1) homeless shelters, (2) collective accommodation for persons with specific residency or migration status, (3) other mass accommodation. Two reviewers conducted study selection and data extraction. Results were summarised descriptively.

Results

Of 3,273 publications identified, we included 90. Citation searching added 39 records (N = 129). Acute respiratory infections accounted for 32% (n = 41) of reports, followed by vaccine-preventable diseases (25%, n = 32), tuberculosis (24%, n = 31), gastrointestinal infections (9%, n = 12), hepatitis A and scabies (2%, n = 3 each). Public health and social measures varied by disease type; overall case isolation (54%, n = 70), symptomatic testing (48%, n = 62), symptom-independent screening (47%, n = 61), and general personal hygiene measures (36%, n = 46) predominated. Outbreak control was demonstrated mainly by measures of disease occurrence at different time points (49%, n = 63), mostly without reporting comparators (65%, n = 82). Unintended consequences of control measures, e.g. social and psychological consequences, were reported in 19% (n = 24) of records.

Conclusions

Published reports provide evidence regarding the use of outbreak control measures in congregate settings, but include limited information on effectiveness and unintended consequences. The lack of standardised reporting on outbreak management highlights an opportunity to strengthen public health evidence.

Key messages

• The published literature yields information regarding the nature of public health measures used to control outbreaks of a range of infectious diseases in congregate settings.

• Stronger evidence on effectiveness and unintended consequences of outbreak control measures is needed to guide evidence-based public health decisions in these settings.