Washington: Homeless Hit Hardest by a Continuing TB Outbreak

An unabated increase in TB continues in King County, Wash., with the homeless being particularly hard hit. Last week, Seattle and King County officials said there were 25 TB cases, including nine among homeless, diagnosed in the first two months of this year. Typically, only 12 cases of TB are found among the homeless in King County each year. The reported TB cases are on par with last year's total of 158 cases, the highest in 30 years.

Efforts by public health workers to find and test homeless people known to have been exposed to TB have intensified, with $10 being given to those who take TB tests. "In order to get compliance, we really have to give an incentive," said Linda Lake, an administrator recently hired to help control the outbreak. Director of TB control for Public Health Dr. Masa Narita said about 300 homeless people who had close contact with infected people have been tested since the beginning of the year.

The homeless are particularly at high risk for contracting TB because they often spend nights in shelters, where close confines can easily spread the disease. Many also have suppressed immune systems from fighting off other diseases. Others are mentally ill and may resist taking medications.

Homeless people diagnosed with highly infectious active TB are provided housing during their six months of treatment and are observed daily to ensure they take their medications and do not mingle with others, thereby transmitting the disease. At any given time, about four patients are housed in $230-a-week rental rooms. Public Health director Alonzo Plough told the King County Board of Health that the projected cost for the homeless outbreak this year is $600,000. This could strain the $2.1 million previously budgeted for TB control before the homeless outbreak.

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