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Tuberculosis Outbreak Spreads Through Homeless Population

Officials say that while 16 people have the respiratory disease, the infection rate appears to be tapering off.

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Tuberculosis is on the rise in Santa Barbara, and an upcoming furlough that will affect operating hours of the county’s clinics, including the Franklin Clinic on Santa Barbara’s east side, has raised concerns. But Dr. Frank Alvarez, the deputy county health officer, said medical professionals who specialize in tuberculosis will be on call 24/7 throughout the two-week shutdown. (Rob Kuznia / Noozhawk photo)

The homeless population in the city of Santa Barbara is experiencing a significant spike in the number of people afflicted with tuberculosis, according to social workers and county doctors.

Officials say the respiratory-disease outbreak has affected 16 homeless people in the past year, some of them members of the Casa Esperanza Homeless Shelter on Cacique Street. That’s up from three homeless people throughout the entire county in 2006. By way of context, in 2007, just 14 new cases of tuberculosis were discovered among Santa Barbara County’s population of about 400,000 residents.

“This is a dangerous situation,” said Ken Williams, a Casa Esperanza social worker, adding that he has never seen a tuberculosis outbreak like this during his 34 years on the job. “Once something like this gets seeded in the homeless community, it’s not easy to get it eradicated.”

The good news, officials say, is that the strain of tuberculosis plaguing the homeless population is not of the frightening variety that is resistant to medication. Also, the rate of newly infected people seems to be tapering off, said Dr. Frank Alvarez, the deputy county health officer.

A bacterial disease, tuberculosis usually — but not always — affects the lungs, and spreads through the air through coughing and sneezing.

Only 5 percent to 10 percent of people who become infected with the disease develop symptoms, which include coughing for three weeks or longer, coughing up blood, unexplained weight loss, night sweats, fatigue, fever and chills.

The 16 homeless sufferers are active cases, meaning they have developed the symptoms. Many more could be infected. Officials say six of them have been members of Casa Esperanza, and the rest came from different locations, including the streets.

Those most vulnerable tend to be people with compromised immune systems, and those who spend a lot of time in crowded indoor facilities, such as homeless shelters. The disease doesn’t typically spread outdoors, Alvarez said.

Although it’s one of the top three deadliest diseases in the world, tuberculosis is rarely fatal in the United States, largely because of the sophisticated treatments available here, Alvarez said. However, if left untreated, it can be fatal.

As for the local homeless population, the alarm bells first sounded in November 2007, at an annual event called Project Healthy Neighbors, a mobile medical clinic for the homeless at the shelter. During the screening for tuberculosis, officials found four active cases — up from zero the year before.

That set off a stepped-up campaign to screen the homeless for the disease. In addition to testing people at Casa Esperanza, the medical professionals — often accompanied by the streetwise Williams — began making regular trips to homeless encampments around town. Often, Williams has handed out restaurant coupons to the occasionally distrusting test subjects as a bonus for participating. The medical crews also made a point to test every homeless person in the system twice a year, doubling their previous goal.

In 2008, they found 12 more severe cases.

Recently, one of the local tuberculosis patients — a man in his mid-30s — died, although Alvarez said his death was the result of “multi pre-existing chronic conditions,” not the tuberculosis.

Alvarez said he is encouraged by a sharp decline in the number of patients who tested negative after testing positive in a previous screening. This, he said, is a sign that the county health department is catching the disease earlier for more and more people.

“I’m confident we’re making a difference,” he said.

Neither Williams nor Alvarez could speculate much on the causes of the increase, or whether the ramped-up screening explains part of it.

Williams said it’s possible a transient may have brought the disease from out of town. The bottom line, he said, is that spikes like this are bound to happen when large numbers of people are living in the streets and in shelters, as they are now.

“As a society, we need to think really clearly about how to address the problem,” he said.

Williams expressed disappointment that local clinics will be included in Santa Barbara County’s unusual two-week shutdown from Dec. 22 to Jan. 5. Necessitated by the state’s deepening financial crisis, the furlough means three-quarters of the county’s staff will lose nearly two weeks pay.

Clinics won’t be hit as hard as other departments — they will remain open Dec. 22, 23, 29 and 30 — but Williams said they shouldn’t be closed, period.

“I think the higher-ups should really look at this and say, ‘These are life-and-death issues,’” he said.

However, Alvarez said that medical professionals who specialize in tuberculosis will be on call 24/7 throughout the furlough. “That’s a public safety function I compare to the fire department,” he said.

Mirroring a nationwide trend, tuberculosis has declined in Santa Barbara County in recent years, to 33 newly reported cases this calendar year, down from 82 in 1993. The trend, though, has been bumpy since 2000, when the number of new cases reported was 22. In 2007, the county reported just 14.

Across the nation, the disease plagues about 4.4 in 100,000 people, according to the Centers for Disease Control and Prevention

In the United States, foreign-born people are 10 times more likely to contract the disease than U.S.-born people, according to the CDC.

Click here for more information on tuberculosis from the CDC.

Click here to learn how to get tested for tuberculosis in Santa Barbara County.

Write to [email protected]

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