Wednesday, February 25, 2015

Tuberculosis Follow-up

I promised an update in my post two weeks ago regarding tuberculosis issues at Sacramento Homeless shelters.

I’ve learned a few things, which I will relate here and now, but hope to wrap things up with a complete understanding of what the shelters are doing, what the risks are, and what homeless folk can do to best prevent exposure to the disease in a later, final blogpost on this topic.

First off, earlier I misreported what happens when homeless people are given a skin test. I now know that the injection that is placed just under the skin on a person’s forearm is a sterile version of the tuberculosis bacteria, itself – called PPD for "Tuberculin Purifed Protein Derivative." When the bump that develops from the injection is “read” two to four days later by a nurse or technician, what is being determined is whether or not tuberculosis antibodies in the tested person’s blood are gathering at the site. If they are, it is an indicator that the person now has or in the past had tuberculosis and will need further screening. If the bump is just slightly swollen and red, that would indicate an absence of antibodies and is an indication the person is free of the disease (and of ever having had the disease).

This indication that a homeless person is free of the disease is the basis for receipt of a county TB Card, good for the duration of one year.

People should know that a valid card DOES NOT mean the person issued the card has warded off the disease for the coming full year. It only means that on the single day the test results were read there was no indication of the presence of the tuberculosis bacteria or its antibodies.

Thus, knowing that all the other guys sleeping with you in a crowned dorm have TB Cards does not mean you are safe from the disease. It only means that you are substantially safer than you would have been were there not a county TB Card program.

TB poster displayed at a world-travel website.
Before roughly July 1, 2013, TB Cards expired after six months; whereas nowadays they are “valid” for a year. Nothing has changed regarding the skin-prick test. Thus, the value of TB cards to protect others from tuberculosis is now as little as half what it was -- since the test is given to a person half as often as it used to be. Not a good thing.

For whatever reason, the United States is relatively safe from the scourge of tuberculosis as compared to other countries. Deaths for TB were 536 in 2011 (the most recent tabulation I found) according to the Center for Disease Control and Prevention. This number is down a whopping 69% since 1992. The CDC also reports that in 2013, 65% of reported cases of TB in the U.S. (which totalled 9,582) were in foreign-born individuals.

Many other First World countries include use of a vaccine (called BCG) that has existed for more than 65 years in combating TB. In the United States BCG is used only very rarely for persons who fit select criteria for its usage.

So, while the outbreak of TB at Florin High earlier this month -- where it was determined 16 students have the disease -- is alarming, the demise of the disease in America over a period of twenty-plus years is of some comfort.

I spoke with Nicole Cable of Primary Care a few days ago. See is responsible for knowing issues relating to the care of homeless people in our county. She tells me that the county does not promulgate instructions re how shelters and other homeless-help charities make use of TB Cards. In my final blogpost on this issue, I hope to have word from most of the prominent shelters in the city about their procedures to protect homeless people from the tuberculosis bacteria.


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