Health officer reports on TB outbreak

EASTON - Talbot County experienced a significant Tuberculosis outbreak in 2017, said Talbot County Health Department Health Officer Dr. Fredia Wadley.

Wadley presented the information to the Talbot County Council during their regularly scheduled meeting on Tuesday, Feb. 13.

"In Talbot County, we rarely see an active case of TB," Wadley said. "But this past year we had one active case that was already on treatment before coming into county, and we had to see that he continued his treatment. But we also had one case that was active TB and we had to do a complete investigation for that."

She said altogether the county had three active cases of TB and 17 latent cases.

"So for us that is a significant TB outbreak," Wadley said. "In fact it will be presented to a statewide conference in April about TB."

According to the Center for Disease Control, a latent TB Infection occurs when the TB bacteria lives within a body without making the host sick. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with a latent TB infection do not show any symptoms, do not feel sick, and cannot spread the bacteria to others.

Patients with a latent TB infection will usually have a positive TB skin test reaction or a positive TB blood test. They may develop TB disease if they do not receive treatment for latent TB infection.

An active TB diagnosis occurs when the patient's immune system is unable to stop the bacteria from growing. According to the CDC, many people can have the latent form of TB, and never develop the disease. The disease occurs when TB bacteria is multiplying in the body this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

Wadley explained how the investigations were conducted by Liz Whitby, Community Health Nursing supervisor for the Communicable Disease department.

"She did a fantastic job at interviewing all of these," Wadley said. "As we say spend a lot of shoe leather in getting this cornered and treated in a very short period of time."

She said investigations include interviewing all close contacts of the patients for symptoms including everyone living within the household and coworkers when applicable.

She said the interviews were followed up by skin test, blood tests and X-rays if needed.

"Once all that is done you decide who is the active and who is the latent," Wadley said. "So within a few weeks we have gotten all the latents treated, and actives are now latent doses."

She explained to the council the difference in treatment for active and latent cases and that the medication is distributed and monitored by the health department to insure the patients are taking them.

"Active patients will take up to four medications daily, and we have to see them take those pills, every day for weeks, and then they will go up to a weekly regimen," Wadley said. "If you are latent, then you will probably have two medications you have to take once a week."

She said this is known as directly observed therapy and because of this strict method the United States has been able to control outbreaks of TB and to prevent resistance to TB medications.

"Over the last year, there were 9,240 active cases of TB in the country," Wadley said.

According to the Maryland Department of Health and Hygiene, Prevention and Health Promotion Administration Center for TB Control and Prevention there were a total of 9,272 TB cases reported in the United States in 2016.

This is a decrease from the number of cases reported in 2015 and the lowest case count on record in the United States.

Wadley said the downside of the low numbers is that doctors tend to forget about TB. She said one of the active TB Talbot County residents had been seen by several doctors over a six-month period and went undiagnosed until a doctor at Choptank Community Health skin tested and ordered an X-ray for the patient.

"That individual had been over the past six months or so seen by two to three doctors for coughing and had been given antibiotics," Wadley said. "Because once you only see 9,240 cases across the country people don't think about it. But that physician was very good to order a skin test and to go ahead and get a chest X-ray."

In 2016, the World Health Organization, Global Tuberculosis Report estimated there were 10.4 million new TB cases worldwide; twelve percent of the 10.4 million new TB cases were also HIV positive.

In Maryland, from 2015 to 2016, TB increased by 26 percent, with Baltimore City's rates increasing by 69 percent. From the overall state increase, 85 percent of cases were foreign born versus 76 percent in 2015.

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