Recent reports of deadly tuberculosis cases among homeless people in Jacksonville have put the infectious disease back in the spotlight. State officials say that Florida cases have been declining in recent years, so much so that the Legislature voted to close the state's last TB hospital.
But public health experts say the disease is still a significant threat. There is no vaccine against the respiratory form of TB, treatment is arduous, and the disease is particularly dangerous to people with compromised immune systems.
To find out more, we spoke with Dr. Beata Casanas, medical director of the Hillsborough County Health Department's TB center, and also an associate professor in the Division of Infectious Diseases at USF Health.
What is FL 046, the strain found in Jacksonville?
It is (named for) the state where the outbreak occurred, in this case Florida, and the original patient's age, in this case age 46.
People who (have been) in contact with this person and test positive for TB are said to have FL 046. (Hillsborough had one reported contact of that Jacksonville patient in 2010 who was successfully treated.)
Since you can get TB just by being around a person who has it, why isn't it more common?
Actually, it's not that easy to get TB. Only about 30 percent of those exposed to TB become infected. And to be infected you need to be in close proximity of an infected person for a prolonged period of time, an average of about eight hours. The person who has the infection has to be very, very sick, coughing excessively, most likely coughing up blood. That's why we are still able to contain it—as long as we can identify and treat the people who come in contact with infected patients.
What's the key to TB management?
The key is treating each case individually. Every patient has different symptoms, a different living situation, other medical problems, everything is different for each patient. We meet as a TB team every Wednesday morning and discuss each patient's case individually with about 12 experts, including doctors, nurses, social workers, case managers, X-ray technicians and others. We review their case and discuss how treatment is progressing. It's also very important to find and treat those who have come in close contact with active TB patients.
Anything new in treatment?
One of the most important developments was the approval in 2011 of a new treatment protocol for people with what is called latent TB, meaning they are infected, they test positive, but they don't have symptoms and haven't gotten sick from it. We are now able to give these people a combination of two drugs, isoniazid and rifapentine, for three months under direct observation (while a health professional watches them take the medicine), to prevent the disease. We treat them before they become sick and can spread the disease.
How many cases does your team follow in Hillsborough?
We average about 80 total cases a year. But last year we had only 46. That was very unusual and I hope it's a new trend.
This story has been updated to reflect the following clarification: One person who came into contact with the strain of tuberculosis involved in the Jacksonville outbreak was identified in Hillsborough County in 2010. Due to incomplete information from the health department, an article last week failed to note the Hillsborough patient, who has been successfully treated for the disease.