The major outbreak of tuberculosis that has struck Atlanta homeless shelters this year actually began in 2009, a Georgia health official said Tuesday.
This year, there have been 14 active TB cases at shelters with the same genetic makeup identified in 2009 in four homeless TB cases, said Dr. Patrick O’Neal, director of health protection for the Department of Public Health.
The outbreak in 2009 was followed by another four cases in 2010, two in 2011 and three each the next two years.
O’Neal told the agency’s board Tuesday that more than half of this year’s cases involve patients who are also HIV-positive. All cases have proved resistant to treatment with the TB drug isoniazid (INH).
O’Neal added that it’s likely that more TB cases will surface this year. The homeless are “an extremely vulnerable population,” he said.
The Fulton County Department of Health and Wellness and the CDC are assisting Public Health in aggressively tackling the TB threat, he said.
Public Health officials also said Tuesday that six Georgians have been tested for Middle East Respiratory Syndrome (MERS), but that each tested negative for the potentially fatal disease.
O’Neal, in addressing the TB situation, said homeless shelters typically “have very poor sanitation and infection control measures.’’ And the “overflow facilities’’ that take in the homeless don’t have to abide by city requirements for shelters, he added.
O’Neal told GHN that the increase in cases this year may have stemmed from the unusually cold winter, which drove more homeless people to congregate in shelters.
Many major cities have seen TB outbreaks among their homeless people, O’Neal said.
The agency is paying for housing for all current TB patients while they undergo “direct observed therapy.”
That generally means a trained health care worker or other designated individual provides the prescribed TB drugs and watches the patient swallow every dose.
The observation helps ensure compliance with the drug regimen and prevents further transmission.
TB is spread through the air from one person to another. The TB bacteria are dispersed into the air when a person with the disease of the lungs or throat coughs, sneezes, speaks or sings. People nearby may breathe in these bacteria and become infected.
The U.S. rate of TB has been declining. Georgia’s tuberculosis rate has also been dropping, but is still higher than the national average.
The MERS testing, meanwhile, came after 90 Georgians were passengers on airline flights taken by a man infected with MERS now being treated in Florida.
Cherie Drenzek, the state epidemiologist, said three of the six Georgians tested were on those flights.
The three had shown respiratory symptoms similar to those of MERS. Another three Georgians showed symptoms after traveling to the Middle East.
Public Health board member Dr. James Curran applauded Drenzek and her team for their quick response and outreach to medical providers about MERS.
The MERS effort is an example of how public health works well, Curran said.