Stephen J. Lee, Forum Communications, Published November 13 2012
Grand Forks health officials link TB outbreak to homeless familyGRAND FORKS - Health officials Monday linked an outbreak of tuberculosis in Grand Forks to homeless visitors who exposed members of a family they stayed with.
Public Health Director Don Shields said officials are continuing to test for the disease.
He announced Friday there were eight cases of “active” or infectious TB, including six adults and two children — one in Phoenix Elementary School and one who is only 5 months old. Three of the adults are in their 20s and three in their 40s. Three of the eight have been hospitalized, he said, and the others are under care at home.
As a public health official, he can say little to identify any person with TB, Shields said. But he did give new details on how it got here and who brought it and who did not.
Online speculation, including on the Herald’s website, has raised questions about the origin of the TB outbreak.
It did come from a certain family who came recently into the community, Shields said.
“They are not refugees and not an immigrant family,” Shields said Monday. “They are folks who are homeless and don’t have an address here in Grand Forks. They are Americans. They traveled through here and stayed with friends, and (TB) passed from them to” members of the family in the house.
“They are folks who have come through town, stayed on couches of people here, and due to the exposure, a child in the house with these folks staying with them came down with TB.”
That child is a student at Phoenix.
“We are testing the rest of the students in that classroom, and we want to see if the rest of the family might have been exposed.”
More than 250 people have been tested. Some can test positive for TB without having an active, or infectious, case of the disease.
More testing will be done today, and health officials will meet again today with leaders at Phoenix school.
“There may be additional members of the family of that first child (exposed), and we want to get clinical confirmation on that,” Shields said.
TB can be lethal, but he doesn’t know of anyone in North Dakota dying this year of the disease, said Shields, who is public health director for Grand Forks and Grand Forks County.
It can spread through coughing, sneezing or speaking, usually through prolonged contact with an infected person in a relatively closed space.
Every year, Grand Forks sees one or two TB cases, Shields said. Typically, the infected person is given medication and, within four to nine months is cured, including a time of staying home.
Among homeless people, or those in jail, it’s more common for TB to continue undiagnosed or untreated, which tends to lead to more people being exposed from such an infection, Shields said.
“It’s safe to say that TB can affect anyone of any race, color, creed or economic status,” he said. “What has happened with the first three people we identified is they are people who are homeless, who most likely did not finish medications that were given to them, and because they were homeless, moved on.”
He said the relatively long period needed for the medication to be taken often means homeless people don’t complete the one-pill-per-day regime that often is needed.
“Alcoholism was an issue with this group, and they were homeless people, so it could be that the involvement with alcohol might have been a higher priority than taking the medication,” Shields said.
“We don’t vaccinate for TB,” Shields said. In fact, it’s uncommon for young children to get it because they seem to have extra resistance to it, he said.
However, one of the eight people with infectious TB in the county is 5 months old, he said.
“You have to have an exposure to people who are infected and a prolonged exposure in a closed environment,” Shields said.
TB is relatively difficult to diagnose because it takes several weeks for lab tests to show results, so clinical exams, which are not entirely reliable, are used, Shields said.
“The good news is we do have time in treating it,” he said. “It’s slow growing, and we do have medications.”
The typical treatment, which is being used in Grand Forks, is a pill per day for four months up to nine months, depending on the acuteness of the TB case. Some TB cases get resistant to certain medications, but there are alternatives.
The shorter period of medication often is a preventive course for people who probably were exposed to someone with an active case, he said.