N.D. Officials Share Lessons From TB Epidemic
Feb. 22--In his introduction to a Grand Forks community tuberculosis panel Thursday, Dr. Raymond Goldsteen called the past few months preceding it a "moment of learning" when it came to managing one of North Dakota's largest epidemics.
Three cases of tuberculosis were publically confirmed in Grand Forks in October. What followed were 13 more confirmed cases, 45 people on medication and more than 900 medical follow ups.
"We think (tuberculosis is) not one we have to worry about," Goldsteen, a UND School of Medicine and Health Sciences professor, said. "But these things occur in North Dakota."
Tuberculosis, or TB, is a potentially lethal infection that usually attacks the lungs but also can affect the kidneys, spine and brain, according to the U.S. Centers for Disease Control and Prevention. It can spread through coughing, sneezing or speaking, but requires close and prolonged contact.
Thursday's panel, "Tuberculosis on the Great Plains: The Grand Forks Epidemic," featured three medical professionals who are on the epidemic's frontline.
As more and more cases were confirmed, investigators such as panelist Shawn McBride, a field epidemiologist with the state health department, needed to use a variety of tools to track the disease's spread.
Several diagnosed with TB indicated they did not have a permanent address and stayed with friends or relatives, complicating the investigation. McBride said some use prepaid phones so their contact numbers can change frequently.
Traditional tools such as conducting interviews with infected patients were used, but investigators also received help from social media.
"People have changing phone numbers, but they always have a Facebook profile," McBride said.
After months of investigation, health officials were able to link almost all of the TB cases to one person, a "super spreader" referred to as Patient G by McBride.
But as panelist Dr. James Hargreaves later revealed, the most contagious patient doesn't always appear the sickest.
As demonstrated by several of the confirmed cases, a variety of tests are often needed to confirm a patient has active TB, according to Hargreaves, an infectious disease expert at Altru Health System in Grand Forks. A patient may present symptoms, but all standard tests can come back negative for TB.
In one case, a lung biopsy was needed before health officials could confirm the patient had TB.
A patient also may test positive for a latent TB infection, the disease's dormant form.
Those with LTBI do not present symptoms and are not infectious, although 10 percent eventually come down with active TB, according to panelist Don Shields, director of Grand Forks Public Health.
Getting TB patients to comply with medical orders is one of the most difficult parts of managing an epidemic, according to the panelists.
"Many don't have health insurance," Shields said. "Their access to healthcare may be in the form of an emergency room."
Treatment for TB involves a medication regimen lasting between six to 12 months. If a patient stops taking medication too soon or takes the wrong dosage, they may become sick again.
Shields said his staff is currently monitoring 25 households to ensure patients are taking their medicine properly.
"Each case requires a lot of work," McBride said, noting the city health department is used to three cases in a year. "Sixteen cases in two months is a lot of strain."
Several TB patients have been provided housing by the state to ensure their treatment stays on track. Others have faced court orders to stay on treatment after they refused to cooperate.
While the investigation has made progress, it is not complete according to Shields.
"The biggest thing for Grand Forks is that this is not over," he said.
Shields, McBride and Hargreaves expect the investigation to continue through at least 2013.
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