TB prevention among homeless faces hurdles

A recent outbreak of tuberculosis among homeless people in New York highlights the difficulty in tracing cases when they're handled by different jurisdictions, according to public health officials.

Dr. J. Hudson, with the Orange County Health Department in Goshen, New York, and colleagues report that 29 TB cases were identified among residents in one homeless shelter between 2000 and 2003. Three local health jurisdictions had received the initial reports.

Examination of the genetic sequence of bacilli from 26 of the 29 cases showed that 11 were a strain of TB associated with the homeless shelter, the investigators report in the CDC's Morbidity and Mortality Weekly Report for February 18.

The earliest case of this TB strain had been diagnosed on three occasions in 1996, 2000, and 2001, but on each occasion the patient failed to complete anti-TB. Only after residing in the shelter for 6 months did the patient complete a full course of directly observed therapy (DOT).

The authors of an editorial point out that 11 cases of TB could have been prevented if the original patient had completed treatment when first diagnosed. "The extensive occurrence of TB in this homeless population underscores the need for strengthening and maintaining interjurisdictional reporting procedures," they add.

SOURCE: Morbidity and Mortality Weekly Report, February 18, 2005.