TB-Prone Homeless Given Free Tests : About 39% Show Positive, but Official Says It’s Not Alarming
Francisco Diaz, his shirt-sleeve rolled up and his arm resting on the table, gazed anxiously at the woman seated across from him.
Dorothy Olinger, a registered nurse with the Orange County Health Care Agency, ran her finger over Diaz’s arm. Finding a small lump, she then measured it. The lump, a reaction to a skin test, measured half an inch.
Diaz had tested positive for TB.
As it turned out, he was not alone.
Diaz, 29, was one of 41 homeless people who had been given free TB skin tests at the Homeless Drop-In Center at the Southwest Community Center in Santa Ana Monday. Because of their substandard living conditions, poor nutritional habits and lack of proper medical care, the homeless are at high risk for developing tuberculosis, a communicable disease that is on the rise.
On Thursday, Diaz and 22 others returned to the center to find out their test results.
Of the 23, nine tested positive. They all were offered free chest X-rays at the Health Care Agency in Santa Ana today to determine if they have active cases of TB.
Diaz, who had moved to Santa Ana three years ago from Mexico and recently has been living in the streets and in shelters, said through a translator that he was worried about his positive test result.
Asked if he planned to return today for his free X-ray, he nodded vigorously.
“ Si! Si! “ he said.
Although the 39% positive test rate was high, Dr. Sasithorn Ratana, Orange County’s TB controller, was not alarmed. She had expected as many as half to test positive.
“Knowing this is a high-risk population, when we see 39%, we’re not too excited--but we are concerned,” she said.
The 39% figure, she said, is in line with national TB rates among the homeless. Because of their poor living conditions, she said, the homeless TB rate is 150 to 300 times higher than the national average.
Last year, the number of active TB cases in the United State increased 1.7%, the first substantial rise in TB in the last 30 years.
In Orange County, during the same period, the number of active cases actually fell slightly, from 300 in 1985 to 284 in 1986.
However, Ratana is concerned for 1987 because, based on the number of cases already reported this year, “it will hit close to 300.”
The free TB skin testing at the Homeless Drop-in Center is the county’s first effort to determine how widespread TB is among the county’s estimated 5,000 homeless. The screening, which marks TB Awareness Week, was co-sponsored by the Health Care Agency and the American Lung Assn. of Orange County.
Sharon Petrillo, program manager for TB control and refugee health at the Health Care Agency, said TB skin tests are planned at other homeless shelters in the county.
Higher Risk Group
People living in such close quarters face an even higher risk of getting TB, she said. The disease is caught by breathing TB germs that have been coughed or sneezed into the air by an infected person. However, frequent and prolonged exposure is necessary for transmission to occur.
Petrillo noted that many of the homeless people tested at the center this week are Latino. Because many of them come from countries with high TB rates, they are more likely to test positive than those who are born in the United States, she added.
Those homeless people whose X-rays indicate that they have active TB cases will be given sputum tests, which will provide a definite diagnosis, Petrillo said.
A positive skin test but a normal X-ray indicates that the person has an inactive case of TB: “They’ve been infected, but their body is controlling the germ,” Petrillo said. An infected person would be put on medication to prevent him or her from coming down with an active case and to keep the person from infecting others.
Three to four different medications, usually in pill form, are used for treating active TB cases. Petrillo stressed that all medication must be taken daily for a minimum of six months.
Free for Uninsured
Although Petrillo said medication for TB is “fairly expensive”--it can run more than $50 a month--the health department does not charge patients who have no health insurance.
Petrillo said the center’s volunteer staff would help locate those who did not return Thursday to check on their skin tests.
She emphasized that TB is curable.
“There’s so much myth that it isn’t because previously it took a long time in a sanitarium,” she said. “It’s really easy if people take the prescribed medication every day. That’s really the key to it.”
Christopher Kusske, 33, who said he’s logged 8,000 miles traveling up and down the West Coast in recent months, needn’t worry about that.
He tested negative.
“It would have really surprised me if I hadn’t,” said Kusske, who has been sleeping in a friend’s car and in shelters. “I’m pretty aware with what’s going on with my own body.”
Still, he conceded, it’s nice to know that he doesn’t have TB.
“I’ve been on the road all summer, and I’ve been around all kinds of people,” he said. “That’s the only reason I took the test.”
