Did Florida Officials Really "Cover Up" an Outbreak of Tuberculosis?

According to a report issued in April, but largely overlooked until an article by Stacey Singer was published in the Palm Beach Press on Sunday, Florida’s Duval County has been fighting a cluster of TB cases—99, to be exact—that can be traced back to a single patient, a schizophrenic man diagnosed with a specific genotype of TB in 2008.

Florida officials had thought that the outbreak was contained, but recent spikes in cases prompted them to call the CDC for assistance earlier this year. While the center’s team was investigating what the report’s lead author would call “one of the most extensive TB outbreaks that [the] CDC has been invited to assist with since the early 1990s, both in terms of its size and rapid growth,” state officials were pushing to defund a TB hospital.  

The problem may be with divergent definitions about what constitutes secrecy. At the heart of the debate is the fact that many of the outbreak patients had “[h]istories of homelessness, incarceration, and substance abuse,” according to the report.

As Singer explained in her Sunday story:

Believing the outbreak affected only their underclass, the health officials made a conscious decision not to not tell the public, repeating a decision they had made in 2008, when the same strain had appeared in an assisted living home for people with schizophrenia.

 “What you don’t want is for anyone to have another reason why people should turn their backs on the homeless,” said Charles Griggs, the public information officer for the Duval County Health Department.”

After the Palm Beach Post broke the story on Sunday, officials in Florida said that Singer mischaracterized what happened and that subsequent to the CDC report, they worked with local hospitals, homeless shelters, and other interested parties. They just didn’t shout it from the rooftops—and they kept it quiet to protect this underserved population, not to neglect it. Another official told News Service Florida, “That population is very contained, they are not really mixing with the general population, so that’s why we have not felt the need to do widespread notification to the public,” according to a follow-up PBP piece. Furthermore, they emphasize, TB cases in Florida are actually declining.

While it is admirable to try to protect the homeless and mentally ill from further stigmatization, it seems that the TB spread beyond that cohort. Of the 99 identified patients, 60 were known to have been “homeless ever.” Seventeen of the 99 did not appear to have any of the social risk factors flagged by the CDC, like homelessness, incarceration, or tobacco smoking.  Six were children, five of whom had identifiable connections to other cases. While the CDC was not able to interview all 99 patients—some had died, others were impossible to track down—it seems clear that some of those affected were not homeless.

Earlier this year, doctors in India warned that they had uncovered a “totally drug-resistant” strain. India denied the report. But cases of multiple-drug-resistant TB are nevertheless rising. Paul Nunn of the World Health Organization told the Guardian in May, “It occurs basically when the health system screws up.” That’s what officials are up against here.


Source : http://www.slate.com/blogs/future_tense/2012/07/11/report_says_florida_officials_may_have_covered_up_outbreak_of_tuberculosis_.html      2012/7/30

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