Worst TB Outbreak in 20 Years Kept Secret

Stacey Singer, The Palm Beach Post, July 8, 2012

The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop.

That report had been penned on April 5, exactly nine days after Florida Gov. Rick Scott signed the bill that shrank the Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tough tuberculosis cases have been treated for more than 60 years.

As health officials in Tallahassee turned their focus to restructuring, Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak—and the measures needed to contain it—went unseen by key decision makers around the state. At the health agency, an order went out that the TB hospital must be closed six months ahead of schedule.

Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville’s homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida’s outbreak was, and is, far from contained.

The public was not to learn anything until early June, even though the same strain was appearing in other parts of the state, including Miami.

Tuberculosis is a lung disease more associated with the 18th century than the 21st, referred to as “consumption” in Dickensian times because its victims would grow gaunt and wan as their lungs disintigrated and they slowly died. The CDC investigator described a similar fate for 10 of the 13 people who died in Jacksonville.

They wasted away before ever getting treatment, or were too far gone by the time it began. Most of the sick were poor black men.


Treatment for TB can be an ordeal. A person with an uncomplicated, active case of TB must take a cocktail of three to four antibiotics—dozens of pills a day—for six months or more. The drugs can cause serious side effects—stomach and liver problems chief among them. But failure to stay on the drugs for the entire treatment period can and often does cause drug resistance.

At that point, a disease that can cost $500 to overcome grows exponentially more costly. The average cost to treat a drug-resistant strain is more than $275,000, requiring up to two years on medications. For this reason, the state pays for public health nurses to go to the home of a person with TB every day to observe them taking their medications.

However, the itinerant homeless, drug-addicted, mentally ill people at the core of the Jacksonville TB cluster are almost impossible to keep on their medications. Last year, Duval County sent 11 patients to A.G. Holley under court order. Last week, with A.G. Holley now closed, one was sent to Jackson Memorial Hospital in Miami. The ones who will stay put in Jacksonville are being put up in motels, to make it easier for public health nurses to find them, Duval County health officials said.


In his report, the CDC’s Luo makes it clear that other health officials throughout the state and nation have reason to be concerned: Of the fraction of the sick people’s contacts reached, one-third tested positive for TB exposure in areas like the homeless shelter.

Furthermore, only two-thirds of the active cases could be traced to people and places in Jacksonville where the homeless and mentally ill had congregated. That suggested the TB strain had spread beyond the city’s underclass and into the general population. {snip}



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