Seattle area sees doubling of tuberculosis cases
Pastor Dale Morgan
Seattle area sees doubling of tuberculosis cases*
Health officials say foreign-born hardest-hit as infection rate soars
By Warren King
Seattle Times medical reporter
Tuberculosis cases in King County this year have doubled compared with
the same period last year, and health officials say foreign-born
residents with the disease are having a significant impact.
Because the disease is well-monitored, authorities don't think there is
an imminent threat of increased spread to other parts of the community.
But they say they're swamped with work as they try to manage the disease.
"We need more help," said Dr. Masa Narita, director of TB control for
Public Health — Seattle & King County.
From January through March, 38 TB cases were reported, compared with 18
in the same period last year. In 2006, the annual total was up 16
percent from 2005 — to 145 cases, with 80 percent of the patients
foreign-born.
"It is concerning, and we have to continue the thorough job we're doing
with case management and timely ... investigations," Narita said.
The proportion of TB patients who are foreign-born has increased from 68
percent in 2003. That has paralleled immigration increases in King
County since 2002 from regions where TB is widespread: Eastern Africa
(immigration up 95 percent since 2002), Central America (up 47 percent)
and Southeast Asia (up 18 percent).
Worldwide, about a third of the population is infected with TB,
including an estimated 100,000 people in King County who carry inactive
TB bacteria, according to Public Health and the federal Centers for
Disease Control and Prevention (CDC). Each year, nearly 9 million people
worldwide become sick — develop active TB — and they can spread the
bacteria through coughing. Nearly 2 million die of TB annually.
Public Health's TB-control staff oversees all new cases, including
watching many patients take their medication to ensure the disease is
stopped and doesn't spread. And staff members interview more than 2,500
people who are in close contact with newly infected people to make sure
they don't have symptoms.
Full treatment typically costs $7,000 to $9,000 per patient. But about
two patients a year in King County are resistant to the two most common
drugs for the disease, as are about 125 patients nationally. Those
patients need up to two years of treatment instead of the usual six to
nine months, and it can cost up to $250,000 each.
Funding for county TB efforts has increased from more than $3.4 million
in 2005 to $4.1 million for 2007, including local, state and federal
money. The increases have included a rise from $780,000 in 2005 to
$877,000 this year to help control an outbreak of TB in the homeless.
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That outbreak began in 2002 with 30 cases, which pushed the annual total
that year to 158 cases, a 30-year high. The homeless cases had decreased
to 16 last year.
Program improvements have included establishing nurse-outreach worker
teams for patient care and working more with public and private clinics
to increase direct observation of medication-taking. Screening contacts
of new patients also has improved.
But Narita said the program needs more staff and money to control the
disease. Public Health, the King County Board of Health and the King
County Executive's Office are looking for ways to do that.
Some experts complain that immigrants and visitors to the U.S. are
insufficiently screened for TB before they leave their homelands. X-rays
to detect the disease are used only on refugees, people seeking
permanent-resident "green cards" or those suspected of having active TB.
Yet even then, X-rays can be outdated by the time the patients reach the
U.S., said Kim Field, director of the state Department of Health's TB
program.
In Seattle, a 58-year-old former Boeing engineer from Vietnam was
diagnosed with TB in January. He said he thinks he contracted the
disease in his homeland more than 30 years ago. But it took many tests
before the disease finally was diagnosed in tissue around a severely
weakened vertebra, which had broken when he sneezed hard and fell down
in pain.
Now the man, who asked to remain anonymous, is not contagious. But
because he is resistant to one drug and allergic to another, he will be
under treatment for up to a year.
"I'm getting better, but it's going to be a long time for me," he said.
"It [the diagnosis] has been a total shock to me."