For public health nurse Meredith Hurley, the discovery that her town had an active case of tuberculosis threatened an infectious disease nightmare that couldn’t have come at a worse time.
The tuberculosis patient was a young man from Saudi Arabia, living in the Boston area to learn English. He’d been coughing up blood for five days while he traveled on buses and subways, went to class, visited the New England Aquarium, shared a hookah, and hung out with seven roommates who jointly rented a house in the densely populated seaside town of Winthrop, Massachusetts. They hailed from China, Italy, Taiwan, Germany and Turkey and spoke six different languages — but little English.
To make matters worse, the Saudi man’s case occurred at a time when the Massachusetts Department of Public Health had abruptly lost two of its four TB control nurses, reportedly due to budget-driven early retirement. “These retirements were not planned for and a contingency plan was not established,” Hurley says.
The episode is a stark reminder that the ancient scourge of TB is still with us, even though many people think the disease was vanquished in this country long ago. It can pop up anytime. The case also underscores how critical it is for front-line public health workers who understand how to control TB to be available when needed.
The sudden appearance of TB in Winthrop is a tiny piece of a big mosaic. A new report from the Centers for Disease Control and Prevention reveals the number of TB cases in the United States rose in 2015, to almost 10,000 reported cases, after nearly 25 years of steady decline.
In Massachusetts, progress against TB appears to have stalled, after declines in the first decade of the millennium. One in five reported cases involves drug-resistant strains of TB, which are far more time-consuming to treat with expensive drugs that carry burdensome side effects.
In its annual TB update last month, state health officials reported 192 active cases in 2015. Though the number appears small, the stakes involved in each case are high — for the affected individual and for public health. “Challenges include high rates of drug resistance, delays in diagnosis and complex medical and social needs of persons diagnosed with TB,” the state report says.
“I was thinking there were seven more people walking around the community with active tuberculosis, and they were probably going to be spreading it to seven more and then 14 more and then 49.”
Winthrop public health nurse
As soon as she heard about the Winthrop case, Hurley — the town’s one-woman public health department — imagined the worst.
She discovered the TB patient had visited clinics three times before getting a proper diagnosis, exposing caregivers and patients each time. That’s not unusual with TB, which is not near the top of many doctors’ list of possible diagnoses.
Hurley began to envision how many people the TB patient exposed in Winthrop, a town of 20,000 residents packed into two square miles.
“We don’t have a lot of space between our neighbors, and for a disease that’s airborne, that can be challenging,” Hurley says. “I was thinking there were seven more people walking around the community with active tuberculosis, and they were probably going to be spreading it to seven more and then 14 more and then 49. It’s a cascading effect.”
Hurley says she badly needed help to figure out how big a problem she was dealing with. Because of the sudden short-staffing at the state health department’s TB control program, she had to enlist the help of a public health nurse in western Massachusetts. Continue reading