TB Outbreak Hits Seattle's Homeless

TB cases in Seattle's King County have hit the highest levels in 30 years. Officials attribute the rise in part to an outbreak of the disease among downtown Seattle's homeless. Starting in summer of 2002, the upsurge pushed the year's total to 158, past the usual 115-130 annual cases. Disease investigators, including, at one time, four from CDC, have worked tirelessly to curb the outbreak, which could take off among the more than 7,300 King County homeless and eventually endanger other populations. Untreated, active TB kills about one in three patients within months.

"It's of great concern.... The homeless present a particular challenge for containing and treating TB," said Alonzo Plough, director of Public Health -- Seattle & King County.

Health officials say the homeless are especially vulnerable because many have impaired immune systems from battling other diseases. Furthermore, they tend to congregate in close quarters where the disease can spread. Investigators are visiting shelters, day centers and a drying-out center for alcoholics, attempting to find and test anyone who has had contact with an infected person. They have tested contacts in at least four shelters with sleeping facilities, three day centers and three medical clinics.

Because of the stigma attached to TB, getting to those who might be infected is not always easy, particularly among the homeless. Heather Barr, a nurse-educator for Public Health's Healthcare for the Homeless Network, said homeless people, when asked about contacts, usually reply, "I'm just a loner." She and her colleagues tell patients they will be helping their friends by leading health workers to them. The goal is to obtain the name and location of a contact, promising the patient anonymity.

"Most people are pretty cooperative [about being tested] when they find out they've been exposed," said Barr. "We give them a lot of education about the disease."

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