The federal Centers for Disease Control and Prevention (CDC) has been called in to analyze the Los Angeles TB outbreak because health workers have identified about 4,650 people who were probably exposed to a persistent outbreak of the contagious disease on downtown Los Angeles' skid row.
Many of these people are not homeless, such as volunteers, employees, people riding public transportation, food handlers, tourists, students, health workers, and others who may have come in contact with the homeless either in the Los Angeles skid row district, in places that feed them or give health care or shelter, or people who may have been riding in public transportation near those with TB. Many homeless people sit in public libraries most of the day, when not in shelters or eating at free food kitchens.
The goal is to try to contain the TB outbreak before it spreads to other areas. The particular strain of TB comes from Los Angeles. It's treatable and not resistant to antibiotics used to treat this strain of TB. Homeless people are vulnerable to TB and other diseases because of nutrition, crowding in homeless shelters where numerous people have persistent coughs, and generally have lesse access to hygiene.
CDC invited to help gather information
Los Angeles County Health Department is still in the process of confirming the number and type of TB cases in the county as the CDC helps with surveillance and statistic gathering, according to the February 22, 2013 Los Angeles Times article, "Los Angeles health officials concerned about TB outbreak on skid row."
In the past half decade there have been identified 78 cases of a unique strain of the contagious disease, including 11 deaths. Sixty of those cases were homeless individuals leaving in the skid row area. But how many cases still have not been identified who may be spreading the disease? TB bacteria can be spread by laughing, speaking while preparing food as small droplets of saliva too small to be seen spray the food, coughing, or sneezing in public transportation or in any room.
The entire USA reported about 10,528 cases of tuberculosis in 2011. Of these, there were 529 deaths from the disease in 2009, according to the latest full year CDC statistics. But not all cases are identified or reported since the CDC responds to TB outbreaks only when state and public health departments exceed their surge capacity to control an outbreak. The CDC has to be asked to participate.
The Los Angeles TB cases follow a pattern of infection
Typically, the CDC will conduct an onsite investigation lasting two to three weeks, working closely with state and local public health partners. According to the L.A. Times article, "the cluster of TB cases going on in Los Angeles follows a pattern of infection. First the CDC invested a review of 51 TB cases. These older cases were investigated between 2002 and 2008 by the CDC. The results of the investigation were published in the journal Emerging Infectious Diseases. Researchers found substance abuse was the most common risk factor, with 58 percent of outbreak patients reporting substance abuse, according to the Los Angeles Times article, "Los Angeles health officials concerned about TB outbreak on skid row."
Of reported TB cases in the USA, there are still more than 10,000 patients every year who get TB. People catch TB from other people with it or from breathing the air in a room, plane, bus, or train where someone with TB is close near. Even though rates of TB in the USA are low, globally more than 9 million people get TB.
The big issue is the USA may not recognize, identify, or treat all the cases in the nation. You have TB coming in on planes and ships that's not screened. Nobody takes a TB test before boarding a plane or a ship. Still, the particular treatable strain of TB is coming from Los Angeles, not from outside the country.
If other strains also are in the country, who's testing for them? And which strains are drug-resistant? For example, student teachers practicing teaching English to students from other lands may be concerned that the students, many of whom are in adult education classes, are not screened for TB. The bacteria is not limited to the homeless.
TB germs are spread by laughing, talking, coughing, or sneezing
Anyone can pick up TB from being close to someone with active TB bacteria just from talking to the person who may not have been screened. That's why student teachers, substitutes, and educational personnel in public schools usually are given TB screening tests before employment.
On the other hand, if someone with TB volunteers to care for newborn babies in hospitals, often they are not screened for TB, unless there's a TB outbreak among nurses and/or volunteers in hospitals. Check out the article, "Mycobacterium tuberculosis Transmission in a Newborn Nursery and maternity ward."
Containing the Los Angeles TB outbreak in skid row
The new TB outbreak in the skid row area of downtown Los Angeles is frequented by a large concentration of homeless people, according to the February 22, 2013 news report, "LA health officials seek to contain TB outbreak." The question is how do you keep it from spreading, since many homeless people and those living near Skid Row ride the public transit, where their coughs and sneezes in a closed space can transmit the bacteria to anyone riding the bus at locations far from Skid Row, such as children, seniors, persons with disabilities, those who don't drive, and anyone else coming into contact with wherever a homeless person carrying the disease roams.
Homeless people down on their luck may have compromised immune systems
If they get sick, they can spread the microbes to anyone coming into contact with them from social workers and nuns to soup kitchen workers and people who sit next to them in a bus, shelter, or in a public library. See, "Emerging Infections: Microbial Threats to Health in the United States."
Federal scientists will be dispatched in the next two weeks to work with Los Angeles officials. The Centers for Disease Control and Prevention (CDC) 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, according to news reports.
Homeless shelters in Skid Row are increasing efforts to urge people to get tested after state and local public health officials alerted them to the outbreak earlier this month. But people who are not homeless often come in contact with the homeless in public places such as libraries, where often the homeless spend their days or in public transportation and in any place where there is close contact indoors, such as a house of worship, park classroom, restroom, or community center.
Some of the homeless pick up TB germs in prison or jail and then spread it to the homeless on the street, including those who are able to spend afternoons in movie theaters near where they hang out or can reach with public transportation. Others may spread TB microbes at homeless shelters. Check out today's news report, "Skid Row TB epidemic is 'alarming,' but the community is well-versed in disease."
Downtown Los Angeles and its hotels attract tourists from Europe and the U.S.A.
Los Angeles County health officials have asked federal officials for help to contain a worsening tuberculosis outbreak among the homeless in its downtown area. County health officials here have identified 78 cases of a particular strain of the TB bacteria. But TB germs aren't limited to the poor and the homeless in neighborhoods such as Skid Row. Recently live TB bacteria was collected just by swiping the eating tray in a plane, where people who are not limited to the homeless travel globally and nationally. See, Protect Yourself from TB, Bacteria & Viruses on Airplanes.
TB bacteria is normally carried in "droplets" ranging from 1 - 5 microns, and M. tuberculosis itself ranges from 0.4 – 1.4 microns in size, so I would recommend a mask with a HEPA filter, which filters particles down to 0.3 microns. The recirculated air in airplane cabins is notorious for carrying germs as well as chemical contaminants. The Plane Clean Air Filter (pictured above) attaches to your personal above-head air nozzle and removes 99.5% of all bacteria, viruses, and allergens from your air stream. Many people wear masks when traveling on airplanes.
Homeless use public libraries during the day for access to restrooms and the Internet
It's easy for TB bacteria to spread from the Skid Row homeless who frequently spend all day in public libraries to use the bathroom where they wash up or to use the computer. School kids coming into a library branch known for attracting homeless people can be exposed to TB microbes just by sitting near the homeless at a public library.
See the articles, "Aurora library taking precautions against TB spreading - Daily Herald," and "Tomgram: Chip Ward." In major cities, the public library has become an asylum for the homeless. And homeless people with TB ride busses and trains or "light rails." Check out the article, ""Endemic tuberculosis, the homeless, and public transportation." Once TB spreads to school children, it can become an epidemic. See, "California School Becomes Notorious For Epidemic of TB ." Also see, "CDC to investigate LA tuberculosis outbreak."
Also see, UV-based Air Purification, A New Way To Fight The Flu. You can use a device that can help purify the air using ultraviolet light. According to Sacramento Bee news reports, a company, UV Flu Technologies, Inc. (OTCQB: UVFT) announced that there is good news for those living in the 47 states that are reporting widespread flu activity. UVFLU has developed the only pure UV based, FDA-cleared, class 2 medical device for fighting airborne infection and is now offering it to consumers.
The Company has spent millions of dollars developing this unit and in the past has sold the unit mostly to hospitals and other medical facilities. But would it work for other microbes such as TB bacteria as it does on the flu virus? Will what affects virus also wipe out bacteria? You can ask the company how it works with TB germs in public places, such the medical device reports it can kill more than one percent of airborne bacteria. Check out the website of the firm and see what it may be able to do.
Ultra violet light medical device gets rid of numerous types of bacteria and viruses
The Company has just launched a Groupon with special pricing during the current flu outbreak, which can be taken advantage of by visiting the Groupon Air Purification site. The Sacramento Bee articles reported that it felt Groupon was the perfect Company to help with the consumer launch given their huge marketing and logistics capability.
The Viratech UV-400 is an FDA Cleared Class II Medical Device for killing over 99% of airborne bacteria, along with a host of other contaminants, including odors, smoke, and toxic chemicals, with every pass, in rooms up to 800 sq. feet. The device is unique in that it uses germicidal ultra violet light to actually kill organic contaminants, versus typical air purifiers which only "trap" contaminants.
You may also take a look at the article, "How Not to Get Sick From a Flight - NYTimes.com." In 2007, Charles P. Gerba, a professor of environmental microbiology at the University of Arizona, swabbed airplane bathrooms and tray tables on eight flights to see what bugs might be lurking onboard. Four out of six tray tables tested positive for the superbug methicillin-resistant Staphylococcus aureus (MRSA), and norovirus, the highly contagious group of viruses that can cause a miserable one- or two-day bout of vomiting, diarrhea and cramping, was found on one tray.
Most of the bathrooms he swabbed had E. coli bacteria. Thirty percent of sinks, flush handles and faucet handles had E. coli, as did 20 percent of toilet seats, according to his research. In another swabbing of a tray where you put your food on in an airplane, another passenger found live TB bacteria.
Resources on the Los Angeles TB outbreak
FAQ: Everything you need to know about LA's tuberculosis outbreak
Tuberculosis Outbreak Hits LA Homeless
CDC chief: Spending cuts threaten public health
Skid Row TB epidemic is 'alarming,' but the community is well-versed in disease
Downtown LA tuberculosis outbreak prompts CDC response
LA Asks for Federal Help With TB Outbreak
Los Angeles Tuberculosis Cases Draw Federal Investigators
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