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Downtown L.A. tuberculosis outbreak prompts CDC response

The Centers for Disease Control and Prevention is dispatching scientists to Los Angeles to mount a new attack on an outbreak of tuberculosis on skid row.

Health workers have identified about 4,650 people who were probably exposed and are trying to track them down for testing and treatment. Local and federal officials are particularly concerned because the cases are linked to one relatively small geographic area and one vulnerable population. But officials are concerned that the outbreak could spread beyond skid row if action isn't taken.

Officials say 11 have died since 2007. Sixty of the 78 cases were among homeless people who live on and around skid row.

"This is the largest outbreak in a decade," said Jonathan Fielding, director of the Los Angeles County Department of Public Health. "We are really putting all of our resources into this."

Scientists have recently linked the outbreak to a tuberculosis strain that is unique to Los Angeles, with a few isolated cases outside the area.

Homeless people are especially at risk of getting TB and of being undiagnosed because they have poor hygiene and nutrition, limited access to healthcare and ongoing contact with infected people. Transmission of the airborne disease is also common because the homeless live in overcrowded areas and are constantly moving among hospitals, shelters and the streets. Many homeless people also have substance abuse or mental health issues that can impede treatment.

"They go from place to place and the likelihood of passing it along is much greater," said Paul Gregerson, chief medical officer of the JWCH Institute, which runs a homeless healthcare program on skid row. "It makes everybody more susceptible."

Tuberculosis is easily transmitted by inhaling droplets from infected patients when they sneeze, cough or laugh. When left untreated, TB can be deadly. The skid row strain can be treated with all anti-TB medications. Treatment lasts six to nine months.

The public health department issued an alert several weeks ago to doctors at emergency rooms, clinics and urgent care centers informing them about the investigation within the homeless community.

Most of the patients are men and about 20% are also HIV-positive, according to the alert, which was obtained by The Times. Six of the eight patients who also had HIV have died.

The increase of TB among the homeless population is occurring even as the county is seeing a decline in overall cases, officials said. There are probably additional cases among the homeless population that have not yet been confirmed.

The health department also issued new guidelines for shelters earlier this year on how to effectively screen and identify patients at risk of tuberculosis. The guidelines urge shelters to appoint a TB liaison and to create a "cough alert" log for tracking patients with persistent coughs.

The county also recommended that shelters determine if incoming clients have been screened and refer those who haven't been to health providers.

The county suggests that all employees and volunteers also be screened for TB because they are also at risk.

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--Anna Gorman and Andrew Blankstein

 
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