Health Officials Work to Contain Tuberculosis Outbreak

Diagnosis of Santa Maria High School Student Only Tip of Iceberg

Wednesday, April 9, 2014
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Santa Barbara health officials have been quietly working for months to contain a tuberculosis (TB) outbreak, and are now ramping up suppression efforts after publicly announcing that a Santa Maria High School student has been diagnosed with the infectious disease.

While the single diagnosis is a cause for concern, prompting both a community meeting on Friday and mass screenings at the school next Monday, the County of Santa Barbara Public Health Department’s grander ground plan has been actively kept under the radar for the past six months due to fears of alienating an already marginalized population and concerns about political backlash.

In 2013, 26 Santa Barbara residents were diagnosed with TB; 16 are North County residents, and nine are of Oaxacan descent. Figures for 2014 are not yet available, said Public Health Department spokesperson Susan Klein-Rothschild. At least one person died in 2013 from the disease (which typically attacks the lungs and has a 50 percent mortality rate if left untreated) and many had let it progress to advance stages before receiving treatment (which makes it much more contagious). Three children younger than 10 years old were diagnosed last year, and one was left severely and permanently disabled.

Five of the Oaxacan cases “have epidemiologic links and the same genetic pattern on their TB isolate,” meaning they are all part of the same transmission chain. The Center for Disease Control declares an “outbreak” when three of more cases display that genetic link, and this week’s high school student case has been connected to the chain. The Public Health Department is currently conducting “genetic fingerprint” testing of each new case to determine if they’re related, but that process typically takes around two months.

Approximately 20 to 25 people are diagnosed with TB every year in Santa Barbara County, but the recent outbreak is noteworthy for a few reasons: an unusual amount of patients had entered the later stages of the disease’s progression before they were administered medical care; a higher number of pediatric cases have been and are still being identified; eight out of the 26 patients from 2013 were resistant to medications (the statewide resistance rate is 10 percent); and the disease appears to have taken a real hold in the Oaxacan community.

In February, Dr. Charity Thoman, Deputy Health Officer for the Public Health Department, issued an alert to North County doctors warning them of the growing pattern within the population. “The Santa Barbara County Public Health Department has been conducting an ongoing investigation of this outbreak,” she wrote, “and is asking medical providers within North County to have an increased suspicion for TB in patients from the Oaxacan community who present with TB symptoms, both in children and adults.”

Thoman explained during an interview this Wednesday that Public Health nurses have been combing North County communities “day and night” in recent weeks, searching for signs of the disease. It’s a challenging assignment, she went on, as some of the Oaxacan individuals may be undocumented and harbor a distrust of government workers. Plus, many of them only speak Mixteco. When nurses make house calls, they are trained to listen for coughs coming from back rooms, Thoman said, noting that rough estimates put the North County Oaxacan population at anywhere between 10,000 and 30,000.

“When we address each case, that’s routine,” Thoman said. “But when we started looking at how they were linked, we became concerned about ongoing transmission. It was no longer business as usual.”

Thoman explained that her department is coordinating with North County medical providers and educators, as well as the California Public Health Department, “to find creative ways to stop the spread,” explaining she expects more cases to be uncovered at Santa Maria High School. Because the TB is airborne — 16 of the known cases were centered in the patients’ lungs — students sitting in close proximity in tight classrooms are especially susceptible, she said.

Those experiencing symptoms of cough, fever, night sweats, and weight loss for more than two weeks should immediately see a doctor and ask for a TB test, Thoman advised. While an estimated three million California residents carry the bacteria that causes the disease, only about 10 percent of them will come down with active TB, which can be cured with medication.

This Friday’s public meeting will be held from 7 to 8 p.m. at the Santa Maria High School Cafeteria at 901 South Broadway.


Independent Discussion Guidelines

This story warrants more prominence, not to mention a major public education campaign. Drug resistant TB is no joke - a real crisis in South Africa because it's so contagious. An in-depth interview with some docs and epidemiologists about ways to deal with it here would be helpful. So many people live in close quarters or even live rough in camps that spread is a real concern, given that a cough is all it takes for spread. This news makes cruise ship passengers with norovirus look pretty benign by comparison.

anemonefish (anonymous profile)
April 9, 2014 at 9:38 p.m. (Suggest removal)

Sorry Anenome but its more PC to rail against the proposed ICE facility..

garfish (anonymous profile)
April 10, 2014 at 4:47 p.m. (Suggest removal)

This is a huge public cost. Property taxes fund public health. The strawberry growers get "cheap labor" and the taxpayers get the bill. More important, the farm workers and their family members infect others. Wow, how many kids came into contact with a high school student or his parents at the grocery store? I can't understand why the folks in Santa Maria aren't raising a fury about all the illegal workers. The iCE facility wouldn't be needed if there were fewer "cheap laborers." Cheap labor is very expensive.

LHThom (anonymous profile)
April 10, 2014 at 7:19 p.m. (Suggest removal)

If this is our Public Health department's efforts to protect the public, placing political correctness over doing their job - they deserve to be fired. This is a FAIL for public health. If I had a child in school who contracted TB, I would SUE the County for failure to inform and failure to act.

The job of public health is to inform and intervene. And yet at the same time the community was livid about an ICE facility going in, the government which is supposed to protect and inform us plays games with information - fearing some reaction. There is no excuse for this type of non-strategy. It certainly does not conform to typical measures for containing TB outbreaks.

Wow. We wonder what is wrong with government - better yet, what is wrong with Mexico that it does not identify and treat these illnesses - and that when it comes to the US, to California, we hide the information, hoping that doctors will find this on their own, school nurses and public health nurses will ferret out these diseases.

Maybe PH department should go out and test the field workers picking strawberries, who seem to be at greater risk for TB infections.

There should be an investigation and the health officer for such a decision should be fired. All SMHS kids and staff should be TB screened, and any positives should have chest x-rays. Let's get going folks.

Shameful. Government at its worst.

The government once again tries to hide what it should make public.


TheEvolOne (anonymous profile)
April 13, 2014 at 10:26 a.m. (Suggest removal)

When I traveled to other countries in the early 70's, you had a passport and more importantly a passport sized yellow booklet with your inoculation history, in order to get into the country. For some reason those yellow booklets are no longer required, we are now seeing mumps, measles, TB etc that were eradicated during my lifetime. I remember the whole community lining up for the sugar cube at the local elementary school, I had a older cousin with Polio.

This is sure one very important reason, that everyone traveling from another location should come through lawfully established Ports of Entry, just ask the American Indians about small pox.

Travelers throughout human history have brought terrible disease with them, it is just a fact, immunization has become complacent in the USA and now we are seeing eradicated disease starting to take hold again.

howgreenwasmyvalley (anonymous profile)
April 14, 2014 at 9 a.m. (Suggest removal)

Could one of the means to containing this dreaded pulmonary disease be to require all homeless shelter populations to be tested by public health officials before admittance? No proof of having been tested, no admittance!

salsipuedes (anonymous profile)
April 14, 2014 at 3:37 p.m. (Suggest removal)

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