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Alarming Rise of Tuberculosis Battled Door-to-Door in Santa Barbara County

Recent statistics indicate local infection rates rival much larger counties, challenging public-health officials

Santa Barbara County is a hot spot in California for tuberculosis rates, rivaling larger counties such as Los Angeles and San Diego.
Santa Barbara County is a hot spot in California for tuberculosis rates, rivaling larger counties such as Los Angeles and San Diego. (California Department of Public Health, Tuberculosis Control Branch map)

Every four hours in California, someone is diagnosed with tuberculosis, and every other day, someone dies of it, state records show.

In Santa Maria alone, the Santa Barbara County Public Health Department has reported two outbreaks of the highly contagious lung disease during the past two years, affecting six adults and three children.

An outbreak occurs when four or more cases of tuberculosis are linked.

In addition, 20 other cases were reported in the county in 2014, bringing the total to 29.

“That’s a pretty high number, and about 30 percent of the total are drug-resistant cases,” said Dr. Charity Dean, the county health officer. “The level of complexity is unprecedented. We’ve never seen this before.”

A state grant of $67,000 last month will more than double the county’s “special needs” budget for tuberculosis, county officials said. Twelve county outreach nurses and aides and five lab technicians are working to control the disease.

“We are maxed out trying to meet all the needs of these outbreaks,” Dean said. “Day to day, our staff is having to really stretch their time to perform all their tasks.”

A report on tuberculosis for Gov. Jerry Brown’s office in 2013, the latest year for which statewide data are available, shows six cases per 100,000 people in Santa Barbara County.

That’s nearly the rate of tuberculosis in much larger metropolitan areas, such as San Diego County (6.5 cases per 100,000) and Los Angeles County (7.1 cases per 100,000).

Those counties together reported more than 1,000 cases of the disease. The average rate of tuberculosis in California is 5.7 cases per 100,000 people.

Dr. Charity Dean, Santa Barbara County’s health officer, says the county is 'maxed out trying to meet all the needs' of local tuberculosis outbreaks. (Lara Cooper / Noozhawk file photo)
Dr. Charity Dean, Santa Barbara County’s health officer, says the county is “maxed out trying to meet all the needs” of local tuberculosis outbreaks. (Lara Cooper / Noozhawk file photo)

Typically, tuberculosis is treated with one antibiotic for six to nine months. But patients with drug-resistant strains of the disease must often undergo treatment for twice as long with multiple antibiotics.

Every day, Dean said, county nurses and aides go door-to-door, visiting patients to watch them swallow their pills. They make follow-up visits after the treatment is over.

Occasionally, Dean said, they have to rely on a language line on their cell phones to convey instructions in Mixteco, the native language of patients from Oaxaca, Mexico.

In addition, the department tries to track down and test everyone who has been in close contact with a TB patient, going back at least 12 weeks.

Last year, 590 at-risk contacts were identified and 308 were tested, said Paige Batson, county director of public health nurses and disease control and prevention.

Many do not complete the testing regimen, she said, because they may be required to undergo more than one blood test over a 10-week period.

“It’s very taxing on us,” Batson said. “We really need to hit the pavement to get people tested.”

In all, she said, 83 contacts in the county last year were found to have a latent tuberculosis infection — that is, they are not sick and cannot be required to undergo treatment.

But between 5 percent and 10 percent of people who have been infected typically develop the disease.

In this way, Dean said, some who were infected during an outbreak in Santa Maria in 2004 have now become active patients themselves.

Among the current tuberculosis patients in the county, some are being isolated in their homes until they are no longer contagious, Dean said. And sometimes, she said, patients violate this rule.

“They don’t understand they are a public health threat,” she said. “I take a pretty tough stance on this.”

Last August, the Sheriff’s Department obtained an arrest warrant for Agustín Zeferino, a 24-year-old Santa Maria man with multidrug-resistant tuberculosis who violated several isolation orders and whose whereabouts are unknown.

Agustín Zeferino

“We still haven’t found him,” Dean said. “We know he goes back and forth to Mexico and may be coming and going in our community. He’s spreading the most dangerous form of TB in the world. Multidrug-resistant tuberculosis without treatment is fatal.”

Drug-resistant strains of the disease develop when patients discontinue an antibiotic before completing their treatment.

A drug-resistant case can require many hours of research by the county health officer and 18 months of antibiotics that cost thousands of dollars per month. Some of these antibiotics must be administered intravenously.

To help prevent tuberculosis, the county plans to launch a campaign through public service ads and outreach to doctors beginning March 24, World TB Day. The focus will be on new treatments for latent infections.

“That’s the cornerstone of TB control,” Batson said.

— Melinda Burns is a freelance writer in Santa Barbara. She can be contacted at [email protected].

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