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Nevada County ready for TB

Nevada County medical officials will huddle this week to identify any areas of tuberculosis concentration, but local officials said they are prepared for the disease.

The meeting comes in the wake of last week’s startling news that an Atlanta man flew to Europe with a drug-resistant strain of tuberculosis.

No such cases of the XDR tuberculosis have been detected here, officials said.



If any areas of TB concentration are found, county medical officials will hand out fliers, and the Public Health Department’s mobile van will be dispatched for screening tests and information.

TB screenings are already routine at the department, when people come in as part of an occupational program or if they might have been exposed, said Dr. Joseph Iser, the county’s health officer and director of public health.




The disease spreads most quickly in “areas where people are concentrated, like jails, nursing homes, schools or airplanes,” Iser said.

When people test positive, “We get them an X-ray to look for evidence of active TB and we go through a full symptom list,” Iser said. “If we need to, I have the authority to quarantine someone with active TB, but I haven’t needed to.”

Symptoms of active TB include a bad cough for three weeks or longer, chest pain and coughing up blood or deep lung sputum, according to the Centers for Disease Control. Other symptoms include fatigue, night sweats, sudden weight loss, chills and lack of appetite.

In the past year in Nevada County, there have been two active TB cases and about 22 latent cases that were treated, according to Iser.

“We made sure we started them with antibiotics immediately, and they stay on them for about six months,” Iser said. “I’m still treating one of them – a young girl.”

About 20 of the latent cases came from being exposed to the two active cases, which can be spread by coughing or sneezing as TB is spread through the air.

People with latent cases typically do not show symptoms and can’t spread TB, according to Allan Finlay, a registered nurse and the infection control officer at Sierra Nevada Memorial Hospital in Grass Valley. But they can develop it later in life, which is why they are treated upon detection, said Finlay.

According to the CDC, about 14,000 cases of tuberculosis occurred in the United States last year, but cases have been declining since the early 1990s. Still, the incidence of tuberculosis among foreign-born people is increasing because of less medical awareness, a trend that showed up here with the recent cases, Iser said.

“Peru was one of the recent ones,” Iser said. “If we lived in San Francisco, we’d see a lot from the Pacific Islands and Asia.”

Iser said there was a cut this year in TB program funding from CDC and that concerns him.

“That’s exactly what happened in the early 1980s when (TB) got out of control,” Iser said. “It could hold up case studies to trace where it came from.”

Hospital alert

According to Finlay, every employee at the hospital is tested for TB every year, and each patient is checked for it upon admission.

TB patients are placed in one of 10 “negative pressure rooms” at the hospital, which are individually vented to the outside, where sunlight kills the bacteria that causes it, Finlay said.

People most at risk include the incarcerated and the “homeless who have been in shelters or living with others,” Finlay said. The high-risk list includes people who travel to or come from other countries and “anyone with a suppressed immune system. People with HIV/AIDS are particularly susceptible,” Finlay said.

If you think you have been exposed to TB and want to deal with it, you can call the county health department at 265-1450.

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To contact Senior Staff Writer Dave Moller, e-mail davem@theunion.com or call 477-4237.

Why is TB a problem?

Tuberculosis used to be the leading cause of death in the United States, but in the 1940s medicines were discovered to treat it.

This caused the number of cases to slide greatly in the 1950s and 1960s, as people who had it were treated. In the late 1970s and early 1980s, money to control TB was cut and the disease made a comeback.

Funds were increased again and national cases have fallen every year since 1992. But a steady increase of cases from foreign-born patients has been reported since 1993. Last year, almost 14,000 cases were reported in the United States, down almost 4 percent the previous year.

Information from the U.S. Centers For Disease Control.


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