While the number of transients in Utah with tuberculosis is small, a handful who aren't cooperating with treatment plans could pose a health risk to homeless shelter staff and residents.
Members of a tuberculosis task force, with representatives from the homeless shelters, state and local health departments, medical clinics and other health care and service providers, met Friday to discuss the issue, which is causing a great deal of concern nationwide.Tuberculosis commonly killed people decades ago, but with proper treatment most people now recover. Symptoms of the illness, which infects the lungs, include coughing, weight loss, fever and night sweats.
According to information released by the Center for Disease Control during a national discussion of health care for the homeless, Salt Lake City is a 1991 "outbreak" area for tuberculosis. The center estimates the disease is active nationwide in 1.6-6.8 percent of the homeless population, while infection rates range from 18 to 51 percent.
Carriers can be infected and never develop the illness, or can develop the illness years after infection. Only 5 percent of those infected get the illness within two years - and another 5 percent get it during their lifetime. Someone who tests HIV-positive is much more likely to develop the active tuberculosis - and in such cases it develops rapidly.
Dr. Harry Gibbons, director of the Salt Lake City-County Health Department, said the report was "flawed" and exaggerates the problem. Screening should be done, he said, if a homeless person exhibits symptoms of the illness.
A recent mass screening of homeless people staying in area shelters didn't find a single active case of the illness, although a number of people tested positive for infection, said LaDene Larsen, state Health Department. The final results of the screening have not yet been compiled, she said.
Several homeless people in the area have been diagnosed with tuberculosis, according to Dr. Barbara McCusker, a TB specialist with the Health Department. "But I could actually tell you the names of the people in the cases that concern us, that's how few there are. The danger is the person who has active, resistant TB and is non-compliant."
Resistive TB doesn't respond to normal treatment and requires additional medication, quarantine and followup. Most TB treatment lasts six months. In a resistant case, treatment continues for six months after tests show the disease is gone.
In one case, a fellow refused to acknowledge he had the illness and would not be treated or take precautions to protect others from getting his illness, which is airborne. Eventually, doctors tried to get a court order to force treatment, since he posed a risk to others. But he disappeared and they have been unable to locate him. McCusker said it takes at least three weeks to get court-ordered quarantine.
"What are we going to do with the identified, contagious, noncompliant person?" Patrick Poulin, director of Travelers Aid, which operates the largest homeless shelters in Salt Lake City, asked. "And what about confidentiality? It hurts me to talk about taking away someone's rights, but if he's identified and out exposing others, are there ways to protect (other homeless people) or the staff?"
Gibbons said his department is aware of several people with the illness, but they hesitate to even share the information with other service providers, because of legal ramifications.
"I just think it's reasonable to try to protect our clients and ourselves," Poulin said.