The mayor of Long Beach, California, is about to authorize a public health emergency in response to a local tuberculosis outbreak.
Dr. Anissa Davis, the city's top health authority, declared the emergency last week after her health department detected 14 cases of tuberculosis at a motel. The City Council vote this Tuesday night will serve as final approval of the declaration.
Nine 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.
In a news release last week, the department stated that “the population at risk in this outbreak have major obstacles to receiving caresuch as homelessness and housing insecurity, mental illness, substance use, and serious illness.”
The department added that it is testing people who were exposed. No new cases have been reported since last week.
The outbreak was reported amid a national surge in tuberculosis cases, the number of which has increased since 2020 after 27 years of decline. The United States recorded 9,615 infections last year, a 16% increase from the previous year.
The emergency declaration should make it possible to free up resources for tuberculosis detection and treatment, according to the Long Beach health department.
“The health department is funded primarily through grants, so we need to have a structure that allows us to put our resources where they are needed most right now,” said Jennifer Rice Epstein, public affairs officer for the health department.
The Long Beach Health Department said it is isolating infectious patients, treating them and providing them with temporary housing, food and transportation as needed.
Homeless people are at higher risk of contracting tuberculosis for several reasons, including substance use – which can weaken the immune system – and living in crowded conditions, where it is more likely to spread. Underlying health problems, such as diabetes, cancer and HIV, also make it difficult to fight TB infections.
“Living in poverty, not having good access to nutrition, not having access to sunlight and fresh air (…) these are all things that They are going to make it much easier for tuberculosis to spread and affect vulnerable people” stated Dr. Luke Davis, associate professor of Epidemiology and Medicine at the Yale School of Public Health.
Davis explained that he is not sure if tuberculosis is actually becoming more common or if it is an increase in diagnoses.
“Are we diagnosing more people? Yes. Does that mean there is more tuberculosis? That’s a little harder to answer,” she stated.
But other doctors who treat tuberculosis patients said the number of cases is increasing, most likely because reduced access to medical care has delayed diagnoses or allowed some infections to go undetected.
“We did millions and millions of COVID-19 tests and fewer tuberculosis tests,” said Richard Chaisson, director of the Tuberculosis Research Center at Johns Hopkins University. “What that means is that people had tuberculosis, went undiagnosed, and continued to spread it to other people.”
Tuberculosis symptoms typically appear up to two years after someone is infected, so people diagnosed now could, in theory, have been exposed during the pandemic, he said.
Additionally, Chaisson added, many public health departments have funding and personnel problems.
“Without increased public health support, we are headed in the wrong direction,” he said.
The U.S. Preventive Services Task Force recommends that primary care physicians screen people at increased risk for tuberculosis, such as those who live in homeless shelters or correctional facilities and those who have lived in high-risk countries. presence of the disease.
But that doesn't always happen, said Dr. Priya Shete, associate professor of medicine and epidemiology at the University of California, San Francisco.
“The increase in cases over time – this year, last year and the next – probably should not be unexpected,” Shete stated, adding that “it is going to continue unless we do something drastic to reverse the trend.” .
The bacteria that causes tuberculosis can spread through the air when someone coughs, sneezes, or talks. It usually affects the lungs, so many people develop a severe cough that lasts three weeks or more, experience chest pain, or cough up blood or phlegm.
Most cases are not related to an outbreak, but rather develop from a latent infection that was never detected, diagnosed or treated. Up to 13 million people in the United States have latent tuberculosis, meaning the bacteria lives in the body without making the person sick. About 5% to 10% of those latent cases turn into active disease if they are not treated.
Treatment for active tuberculosis usually involves taking antibiotics for at least six months, although some treatments can last a year or more.
