TB outbreak in N.D. still under investigation

Health officials continue to investigate the recent tuberculosis outbreak in Grand Forks, which has been associated with 16 cases of active TB.

Thirteen of the cases dated from the end of September and early October, and the other three were cases from earlier in the year, said Dee Pritschet, a TB controller with the North Dakota Department of Health.

That number is up from previous years. North Dakota had 12 cases of active TB in 2010, five cases in 2009 and three in 2008, according to the health department.

Tuberculosis is a bacterial illness that usually — but not always — attacks the lungs. According to the Centers for Disease Control and Prevention, TB is spread when an infected person coughs, sneezes, speaks or sings. It isn’t spread with handshakes, sharing drinks or even by kissing.

Symptoms of TB include a severe cough lasting three weeks or more, chest pain, coughing up blood or sputum, weakness or fatigue, loss of appetite, weight loss, chills, fever and night sweats, according to the CDC.

People who are infected with TB can become sick, with active TB, also called TB disease. But they can also have TB bacteria inside their bodies without having any symptoms, without feeling sick and, importantly, without being contagious. Those people have latent TB.

“Very seldom do we have any active TB (in Stutsman County),” said Marcia Bollingberg, director of nursing at Central Valley Health District. “We do have some people, on occasion, we do have to treat for latent TB.”

In North Dakota, reported cases of latent TB have gone up in the past few years, from 322 in 2007 and 430 in 2008 to 564 in 2009 and 574 in 2010, states a health department report.

Those numbers may not include everyone with latent TB, because generally, only certain groups are tested. The tests aren’t needed for people at low risk of infection, according to the CDC.

Those who should be tested include people who have spent time with someone who has active TB, people whose immune systems are compromised, people with TB symptoms, people from countries where TB is common, people who use illegal drugs and people who live or work somewhere that TB is more common.

Those places are generally buildings without much air exchange, Bollingberg said, including jails, prisons, hospitals, nursing homes and homeless shelters.

Health care workers are also commonly tested for TB, Bollingberg said. At Central Valley, all the employees who work with at-risk people are screened for TB annually.

Central Valley does administer tuberculin skin tests, known as Mantoux tests. A drop of fluid is injected into a person’s arm just below the surface of the skin, and if the injection site is raised, hard or swollen, it will be measured. If the reaction reaches a certain size in 48 to 72 hours, the patient is referred to a physician.

A positive Mantoux test can indicate infection with TB bacteria or, sometimes, an allergy. A doctor will need to do further testing by taking X-rays of the lungs or by doing a blood or sputum test.

A person with latent TB should be treated for it with a drug regimen that lasts for three to nine months. The state of North Dakota will provide the treatment at no cost to the patient, Bollingberg said.

Someone with active TB needs to be treated for six to nine months, and if treatment isn’t fully completed, the person can become sick, and his or her bacteria can become resistant to those drugs.

Usually, Central Valley sees about two or three people a year with latent TB, Bollingberg said.

“There are always people who are being treated for latent TB,” she said. “… there are always going to be little pockets.”

In the case of the Grand Forks-area TB cluster, every reported case has been American-born. Risk factors include substance abuse, incarceration in a correctional facility, lacking a permanent residence and being of American Indian descent, the health department stated in an advisory.

“My best advice I can give people is, if they have been notified as being a contact to one of our active cases of TB, is to go in, and get tested,” Pritschet said.

She said the investigation of the Grand Forks cluster will likely continue for months, as health officials continue to follow leads and investigate the cases.

“It’s not like other types of illnesses … the best prevention is for those who are diagnosed to get treated, so that they can’t pass the infection on to other people,” Pritschet said.

Sun reporter Kari Lucin can be reached at 701-952-8453 or by email at klucin

@jamestownsun.com

Tags: life, health