United States: The City Council of Long Beach, California, has authorized a public health emergency in response to a local outbreak of tuberculosis.
The city’s health officer, Dr. Anissa Davis, declared the emergency last week, after its health department detected 14 tuberculosis cases at a single-room occupancy hotel. The City Council vote on Tuesday night served as the final approval for the declaration.
Nine (9) tuberculosis patients have been hospitalized, and one has died, according to the health department. As of Monday, about 175 people had been exposed to tuberculosis as a result of the outbreak, according to NBC News.
In a news release last week, the department said, “The population at risk in this outbreak has significant barriers to care, including homelessness and housing insecurity, mental illness, substance use, and serious medical comorbidities.”
The department added that it tests people who are exposed. No new cases have been reported since last week.
The outbreak was reported amid a national rise in tuberculosis cases, which have increased since 2020 after 27 years of decline. The US recorded 9,615 active infections last year — a 16% increase over the previous year.
The emergency declaration should free up resources for tuberculosis screening and treatment, according to the Long Beach health department.
“The health department is mostly grant-funded, so we need to have the structure in place so that we can get our internal resources where they’re needed most right now,” said Jennifer Rice Epstein, the health department’s public affairs officer, as NBC News reported.
The Long Beach health department said it is isolating patients who are infectious, treating them and providing them with temporary housing, food and transportation as needed.
These individuals have a high risk of developing tuberculosis because one of the reasons may be substance use – which can lower the immune system – and secondly, they either live in overcrowded environments or in tents and shelters where it is even more likely to spread. Also, respiratory diseases make you more vulnerable to different infectious diseases such as diabetes, cancer, and HIV.
Not being able to live with dignity, having no means to feed properly, staying in the crowd, and having poor ventilation — all these are what will help tuberculosis to spread easily and thrive among vulnerable people, according to Dr. Davis, a Yale epidemiologist and medicine executive.
Davis would not be able to tell – it could be as a result of an escalation in TB occurrences, increased diagnosis, or it could be anything in between, as indicated by NBC News.
“Are we diagnosing more people? Yes, we are. Does that also mean there’s more TB out there? That is a little bit more difficult to answer,” he said.
But other doctors who treat tuberculosis patients said case numbers are indeed rising, most likely because reduced access to medical care delayed diagnoses or allowed some infections to go undetected.
“We did millions and millions of tests for Covid and fewer tests for TB,” said Richard Chaisson, director of the Johns Hopkins University Center for Tuberculosis Research. “What that means is that people had tuberculosis, it wasn’t diagnosed, and they continued to transmit it to other people.”
Tuberculosis symptoms usually manifest up to two years after someone is infected, so people who are diagnosed now could theoretically have been exposed during the pandemic, he said.
What’s more, Chaisson added, many public health departments are stretched for funding and staffing.
“Without increased public health interventions, we’re on the wrong course,” he said.
The US Preventive Services Task Force advises asking for tuberculosis screening from primary care doctors of people whose life situation poses a higher risk for tuberculosis, such as people living in homeless shelters or correctional facilities and those who used to live in countries with high rates of tuberculosis.
However, the situation often is not so straightforward, as stated by Dr. Priya Shete, an associate professor of medicine and epidemiology at the University of California, San Francisco.
“I mean, not many of us were surprised with the statistics of the cases increasing this year, last year and the few years to come for obvious reasons. If we didn’t do anything drastically to reverse the trend, things will probably be the same,” Shete stated in her article which was covered by NBC News last week.
An airborne bacteria transmits in someone’s mouth upon coughing, sneezing, or speaking by the tuberculoid agent. More today than 40 years ago, pneumonia mainly attacks the lungs, making people have a cough that lasts at least three weeks and suffer from chest pain. That is why people tend to cough up blood or phlegm.
In most instances, patients with ACTIVITIES are not directly linked to the outbreak, but occur due untreated or undetected infection had been in a latent stage. It is estimated that there are 13 million people in the US, whose tuberculosis is not active which means they have the disease in their bodies without showing any signs of it. Of those few with hidden infections, 5 to 10% get worse and develop the virus latently if they remain untreated.
Treatment of TB cases mostly entails antibiotic use for six months, though some can go up to one year and a day or two.