Tuberculosis outbreak in downtown L.A. sparks federal effort
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Public health officials have launched a new, coordinated effort to contain a persistent outbreak of tuberculosis in downtown L.A.’s skid row, including searching for more than 4,500 people who may have been exposed to the disease.
The Centers for Disease Control and Prevention have dispatched scientists to Los Angeles to help local health officials figure out why the disease is spreading and how to stop it.
Nearly 80 tuberculosis cases have been identified and 11 people have died since 2007, most of them homeless people who live in and around skid row.
Scientists have recently linked the outbreak to one tuberculosis strain that is unique to Los Angeles, with a few isolated cases outside the area.
“This is the largest outbreak in a decade,” said Jonathan Fielding, director of the Los Angeles County Department of Public Health. “We are really putting all of our resources into this.”
Health workers have identified about 4,650 people who probably were exposed and are trying to track them down for testing and treatment. Local and federal officials are particularly concerned because the cases are all linked to one relatively small geographic area and one vulnerable population. Officials are worried the outbreak could spread beyond skid row if action isn’t taken.
Homeless people are especially at risk of getting tuberculosis and of being undiagnosed because they tend to have poor hygiene and nutrition, limited access to healthcare and ongoing contact with infected people. Transmission of the airborne disease is also common because they tend to live in overcrowded areas and to continually move among hospitals, shelters and the streets. Many homeless people also have substance abuse or mental health issues that can impede treatment.
“They go from place to place and the likelihood of passing it along is much greater,” said Paul Gregerson, chief medical officer of the JWCH Institute, which runs a homeless healthcare program on skid row. “It makes everybody more susceptible.”
Tuberculosis is easily passed along. It is contracted by inhaling droplets from infected patients when they sneeze, cough or laugh. When left untreated, the disease can be deadly. The skid row strain can be treated by all anti-TB medications. Treatment lasts six to nine months.
The health department issued an alert several weeks ago to doctors at emergency rooms, clinics and urgent care centers informing them about the investigation within the homeless community. Most of the patients are male and about 20% are also HIV positive, according to the alert, which was obtained by The Times. Six of the eight patients who also had HIV have died.
The increase of tuberculosis among the homeless population is occurring even as the county is seeing a decline in overall cases, officials said. There probably are additional cases among the homeless that have not yet been confirmed.
The health department also issued new guidelines for shelters earlier this year on how to screen and identify patients at risk of tuberculosis. The guidelines urge shelters to appoint TB liaisons and to create a “cough alert” log for tracking patients with persistent coughs. The county also recommended that shelters determine whether incoming clients have been screened and refer those who haven’t to health providers. The county suggests that all employees and volunteers also be screened for TB because they are also at risk.
As part of the ongoing investigation, the public health department asked shelters last week for information about everybody who has used their services. In the Feb. 12 letter, Peter Kerndt, acting director of the county Tuberculosis Control Program, said the information “is necessary to investigate the increase in TB cases so that appropriate steps can be taken to prevent and control the spread.”
Officials at local shelters said they are committed to work with public health officials.
“We’re trying to understand the urgency of what the CDC and L.A. County Health is doing,” said Midnight Mission spokeswoman Mai Lee. “It does raise questions and concerns.”
At the Union Rescue Mission’s health clinic, officials said they are taking a much more proactive approach to TB screening: going to the patients rather than waiting for them to come to the clinic. Mary Marfisee, medical director of the UCLA School of Nursing Health Center, said teams of students began searching the area this week for people who are most at risk.
“We are testing everybody who is willing to be tested,” she said. “And those who aren’t willing, we are trying to talk them into it.”
Union Rescue Mission’s chief executive, Andy Bales, added that his staff members are making sure any clients with a cough are sent immediately to the clinic for evaluation.
-- Anna Gorman and Andrew Blankstein