Oregon: TB cases at mission triple to 90

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April 11, 2001

TB cases at mission triple to 90 By TIM CHRISTIE The Register-Guard

Recommend this story to others. The number of guests and staff of the Eugene Mission homeless shelter who have tested positive for tuberculosis has tripled in the past 10 days, Lane County's public health officer said Tuesday.

Skin tests conducted on more than 200 people have confirmed that 90 of them are infected with the bacterial disease, Dr. Sarah Hendrickson said.

That number has climbed from the 30 to 35 cases first reported publicly 10 days ago at the mission, at 1542 W. First Ave. Public health officials have undertaken a massive screening effort since then, Hendrickson said.

A positive test indicates that TB germs are in the body but doesn't necessarily mean the person is infectious or will come down with an active case of TB.

Public health officials are preparing to launch a 60-day course of preventive drug therapy at the mission as early as tonight to keep infected people from getting sick and to prevent the potential outbreak from spreading beyond the mission population.

Health officials suspect that the disease began this winter when a single guest of the mission who had an active case of TB spread it to other guests and staff.

So far, seven other people have come down with active cases of TB, Hendrickson said. But there's been no "secondary spread," she said, meaning that none of the people infected by the original source of the disease have spread it to others.

TB is hard to spread compared with other diseases, such as the flu or measles, Hendrickson said. But some people with active cases "seem to cough up a lot of TB germs," she said.

"The fellow who caused the problem last winter was one of those people who coughed up lots of TB germs," she said.

The eight active TB cases from the mission nearly equals the total number of TB cases in Lane County in all of 2000. There were 10 TB cases reported in Lane County last year and 119 in all of Oregon, according to state Health Division statistics. Lane County has averaged 12.3 TB cases a year over the past seven years.

Most Oregon cases are clustered in the Portland area and along the Interstate 5 corridor.

The health department is preparing to set up a clinic in the mission to give infected people a 60-day course of two different drugs - rifampin and pyrazinamide - to keep them from getting sick. Called direct observed therapy, it's become standard practice for treating TB.

"You watch them take their pills; that way you know you get rid of TB," she said.

While the same protocol would be followed among any group of infected people, it's especially important for those at the homeless shelter, she said.

"The folks at the mission tend to be folks who haven't been able to get their lives together," she said.

Guests of the mission tend to have risk factors for TB, she said, which include being homeless; being injection drug users; being foreign born; sleeping in crowded places; or having compromised immune systems.

But she said people who stop in at the mission or volunteer are at no risk for contracting TB.

Mission officials declined Tuesday to comment on the potential outbreak and referred inquiries to Lane County public health.

Tuberculosis, one of the oldest diseases known to humanity, is caused by a bacteria that can attack any part of the body but usually assaults the lungs.

TB was once the leading cause of death in the United States and is still the leading infectious cause of death worldwide.


-- Martin Thompson (mthom1927@aol.com), April 12, 2001


TB Cases On Rise In Diverse Region E-Mail This Article Printer-Friendly Version Subscribe to The Post By David Cho Washington Post Staff Writer Thursday, April 12, 2001; Page VA03

When talking to residents about tuberculosis, the staff of the Fairfax County Health Department speaks 32 languages. In Arlington County, health officials advertise tuberculosis tests on foreign language radio shows. In most Northern Virginia schools, students who have been overseas for five months or more must be screened for TB.

These efforts have become necessary, public health officials say, because tuberculosis cases are rising in Northern Virginia. And more than 90 percent of those who have the disease are foreign-born residents.

Northern Virginia's TB rate is rising at a time when state and national levels have plummeted to record lows.

The disease, a bacterial infection that usually attacks the lungs, is rare in the United States. But it is the most common infectious disease in the world. An estimated 1.7 billion people -- about a third of the world's population -- carry a dormant form of TB, although only a tiny percentage of them develop the disease.

According to preliminary figures from the Centers for Disease Control and Prevention in Atlanta, the number of TB cases in 2000 was down nationally, to 16,372, the lowest on record and a 6.6 percent decline from 1999.

In Virginia, the number of cases dropped from 334 to 292, down 12.6 percent to a record low. In contrast, Northern Virginia had a five percent rise in TB cases.

Leading the way was Fairfax County, which had 89 cases, the highest of any county and more than half of the 149 reported in Northern Virginia. Arlington had the highest rate in 2000, with 16.9 cases per 100,000 residents. Both counties have large immigrant communities. Alexandria also had a high rate, though the number of cases -- 15 -- was low. Occurrences in Loudoun and Prince William counties did not contribute significantly to the increase in TB cases.

There were no reported deaths from TB in the region.

The increasing diversity of the area during the last 10 years has led health departments to diversify their staff to effectively reach those who carry the disease.

"Public health today is especially challenging because not only must we have competence in the subject matter but also in cultures and languages," said Linda Fisher, director of the Fairfax County Health Department. "Within the last 10 years, we've come to really feel that fully in Fairfax County."

Because immigrants can be skeptical of public health initiatives, health workers have to be culturally sensitive and sometimes a little creative in their approach.

In Arlington, for instance, health workers visit English as a second language classes and hand out pamphlets at soccer games and at the county fair, said Jan Tenerowicz, the county's communicable disease bureau chief.

"Arlington has always had a lot of immigrants, so we are accustomed to dealing with them," she said.

Public health officials cautioned against thinking that immigration itself is the problem.

"Immigrants aren't the cause of disease; tuberculosis is the enemy here. In public health, we recognize that," said Charles Konigsberg, director of Alexandria's health department. " 'Immigration' is a real general term, anyway. It's just that some, because of conditions in their own country, may be more at risk."

Some health officials are reluctant to identify individual ethnic groups that are more likely to be exposed to TB. But others said those from poor areas of Africa, Southeast Asia and Latin America are more at risk. Also, TB is often a complication of AIDS.

In other areas of the world, TB is almost as infrequent as in the United States. Fairfax County public schools exempts from its screening requirement children who emigrate from Western Europe, Canada, Australia or New Zealand, a policy that was implemented just a few years ago, said Michelle Bachus, communicable disease coordinator for the county.

Bachus said the recent attention on TB in Northern Virginia, including a news conference held in Fairfax County last month, was a planned initiative by public health officials.

"I think public health policies have been effective because TB is on the decline around the country," Bachus said. "But because it's declining, people tend to get a little complacent and don't realize it's still around. We just want to keep folks aware."


-- Martin Thompson (mthom1927@aol.com), April 12, 2001.

April 12, 2001

Provinces not told of TB risks in immigrants: study

Heather Sokoloff National Post Thousands of immigrants the federal government knows are at risk for developing tuberculosis are not being monitored by provincial health authorities, according to a study released yesterday by Queen's University.

Citizenship and Immigration Canada is failing to notify local authorities about immigrants from countries with high rates of tuberculosis who require long-term surveillance, according to the study, which was partially funded by the federal immigration department.

In almost half of the 26,350 cases where landed immigrants were flagged as being high-risk, the appropriate provincial authorities in British Columbia, Alberta, Ontario and Quebec were not alerted, the study said.

"This is an alarming finding someone needs to address," said Dr. Wendy Wobeser, the study's principal investigator and an assistant professor of infectious diseases at the Kingston, Ont. university. "There was always a concern there was a communication problem between the federal government and the tuberculosis control authorities, but the degree of fall-off was surprising."

Immigrants with active tuberculosis are refused entry to Canada. However, immigrants from countries with high rates of infection may have inactive tuberculosis and could develop the life-threatening disease over time and infect others, Dr. Wobeser said.

Lorna Tessier, an immigration spokeswoman, called the study "a bit alarmist."

The department created a medical surveillance unit five months ago to ensure that information from federal authorities has been received by the appropriate tuberculosis control authority, which varies in each province, she said.

Ontario health officials said they are aware of the communication problem. "That is why we have been working with the federal government to help them enhance the way they communicate tuberculosis- related information to us," said Dan Strasbourg, spokesman for the Ontario Ministry of Health.

However, in British Columbia, where 65% of TB cases occur in immigrants, a health official said the province could do little to monitor people who have not been diagnosed with TB.

"Because of the free country we have, once people are accepted as immigrants ... there is no way for us to make them check in with us," said Pedro Arrais, spokesman for the B.C. Ministry of Health.

http://www.nationalpost.com/news/national/story.html? f=/stories/20010412/531378.html

-- Martin Thompson (mthom1927@aol.com), April 12, 2001.

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