Raleigh shelter follow-up: No transgender link found
Raleigh shelter follow-up: No transgender link found
Countywide TB screening protocols needed
A recent TB outbreak among the homeless population in Raleigh, NC, is not related to another outbreak among transgendered people in Baltimore and the New York City area, say Wake County (NC) TB controllers. (See TB Monitor, June 2000, pp. 57-58; December 1999, pp. 129-130.)
Links originally were suspected because Raleigh is close to an interstate that links Miami and New York and because some of the nine Raleigh patients were, like patients in the Baltimore outbreak, transgendered individuals who are HIV-positive.
Isolates from the nine Raleigh cases (plus a 10th case from a nearby county) show nearly identical restriction-fragment-length polymorphism (RFLP) banding patterns. So it looks as if transmission occurred principally at the crowded, city-run overflow shelter, says Wake County TB controller Peter Leone, MD.
Now Leone is grappling with how to prevent more transmission at that shelter — which recently has been taken over by the county health department — and at other area shelters as well. "We need to decide what’s the most reasonable way to screen in the shelters," says Leone. "There’s really nothing written in stone. It all depends on your resources and the characteristics of the homeless population."
With a highly transient population of homeless people and scant resources, he’s leaning toward a mix of low-cost approaches, including teaching shelter staff how to screen for symptoms, establishing on-site health care at the shelters, and conducting regular skin testing of staff.
There will be changes inside the shelter, too. Instead of long rows of beds inches apart and head-to-head, Leone has spaced the beds five feet apart, and turned them head to toe.
There’s not much that can be done about ventilation, since the warehouse is windowless. A big exhaust fan doesn’t help much because it stirs up mold and dust and sucks out heat in winter or cold air in summer.
But there will be a "sick bay" area set apart from the rest of the warehouse. Leone says that a new shelter now under construction will have better ventilation, UV lighting, and other amenities as well.
For now, Leone is determined to provide on-site care for at least the basics — respiratory symptoms, HIV counseling and testing, and direct observation for the 18 residents who are tuberculin skin-test positive. They’ll get two months of pyrazinamide and rifampin, Leone adds.
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