With a wave of new immigrants from foreign countries and a number of international travelers not taking the proper precautions, Chelsea Health Department officials are keeping a close eye on an uptick in active and latent tuberculosis (TB) cases in the city – though they hasten to call it an emergency or any cause for alarm at this point.
Health Agent Luis Prado said that some time last fall, the official TB numbers kept by the state and reported to the City began to creep up. While Chelsea has historically always had a high TB rate in its modern history, the recent increase was enough to take notice.
“When we noticed there was a slight increase, we immediately began looking to see if it was a trend or what it was that was happening,” Prado said. “It’s small numbers. It could be that people just arrived with it. It’s not an emergency by an means, but it has to be investigated…Recently the rate went up again and we are concerned about that.”
TB is a disease of the lungs that, when active, is very contagious. It is often associated with severe coughing in its active form. TB is not that common in the U.S., but is far more common in other parts of the world, particularly in developing countries that don’t have a strong health care structure.
The state has a comprehensive system in place to report and monitor active TB cases that works in conjunction with local governments such as Chelsea. Within that system, the City’s public health nurse is called upon to monitor and witness all treatments of reported cases, and the state is required to keep and share statistical rates on the numbers of cases.
The current rate is at 18.4 cases per 100,000 people, which is actually a decrease from 2000 numbers but an increase from 2004. In 2000, the rate was 24/100,000, but in 2004 it was 14/100,000. The recent increase up to 18 has taken place over the last year.
One reason for the increase is people who are coming into the country undocumented and therefore not getting the typical health screenings that a legal entrant must get. Often, those coming under these circumstances are fleeing war, refugee situations or extremely hostile conditions, and the last thing on their minds is their health status.
“There are 15 million refugees in the world now and out of that number, the U.S. only accepts 60,000 refugees a year,” said Prado. “These people are traveling and looking for ways to come to the U.S. This is where immigration reform comes into it. Many times they are fleeing war or other conditions and they may be sick or ill, but the chances are you are coming from a place or situation where there was no public health sense or no treatment. That’s why people from other countries are seen as people who are potentially at-risk.”
He added that the stalling on immigration reform federally has only made the problem worse.
“There is a process they could follow that is more clear and this hurts the country because people come here without the proper checks,” he said. “No one comes here to infect anyone or do harm, but if they don’t know about it or aren’t in a position to address their health, that doesn’t benefit anyone.”
That said, another problem in Chelsea is people traveling to other countries and not heeding State Department warnings. Prado said many times people take vacations without noting the warnings regarding public health.
“When people travel there are advisories and precautions they should take, but maybe people who are traveling don’t always pay attention to this or don’t take it seriously,” he said. “The State Department has published clear warnings and they should be heeded by travelers.”
Public Health Nurse Mary McKenzie is charged with monitoring all of the reported cases that are forwarded to the City from the state Department of Public Health (DPH). The DPH has a vast database where, by law, health professionals must log in any TB cases they encounter. That information is then forwarded to McKenzie and she must make weekly home visits to ensure and witness treatment.
Treatment includes a regimen of pills that lasts nine months, and those with TB must have McKenzie as a witness to the treatment until cured.
McKenzie said she is not overly concerned about the recent increase in active cases, but she is concerned about latent TB cases. Active TB is well-known for its persistent coughing and wheezing, with patients often coughing blood and lung tissue. However, one may not even know they have latent TB unless a doctor tests for it.
However, McKenzie said many health professionals don’t tend to report latent cases, even though it is also required.
“A lot of times they just don’t report it,” she said. “Most people that are from other countries; they aren’t treated for latent TB in other countries or the medication costs money and they cannot afford it. So, they just let it go. The treatment, though, is 90 percent successful at that stage and they won’t go on to active TB. Unfortunately, a lot of people from other countries don’t believe they have TB unless they’re coughing up blood. It’s a Catch-22. We are keeping an eye on the situation now, but if we could convince people to treat latent TB, we could see a real decrease in TB cases.”
That’s where an educational component comes in.
Instead of discussions about federal policy and other such things, Prado said the critical piece locally is to educate the public about travel restrictions and about treating latent and active TB. He said seeing a doctor and getting screened is of great importance.
“At this moment, what would really help is to have more education in the community and the population that we work with,” he said. “We need more education about TB for people who travel or who have just arrived and are at-risk. We have to educate the public that this isn’t an emergency, but something that is preventable and people need to take care of themselves. It’s important for people to take care of themselves and talk to their doctor and get a screening.”