MPR News (07.18.2013)
Sheboygan County, Wisc., recently activated its emergency operation center to contain a multidrug-resistant TB (MDR TB) outbreak in the city of Sheboygan in April. Public Health Nurse Jean Beineman identified the initial MDR TB infection in a woman from a large, close-knit immigrant family. Health workers subsequently diagnosed active TB in three other family members in multiple households; some were middle and high school students.
Wisconsin has large immigrant populations from Mexico and Southeast Asia, where TB is common. TB infections among Hmong immigrants from Laos and Cambodia have been the most difficult to cure.
To address the outbreak, Sheboygan County borrowed personnel from other counties; provided housing to isolate the MDR TB-infected woman; and supplied TB testing, treatment, and public education for residents. Beineman reported that the health department tested 130 students and teachers who had been in contact with the TB-infected children and located nine cases of active TB in five households; the cases were not as drug-resistant as the first case. Health department personnel also have supplied education and monitoring to keep TB-infected individuals away from the uninfected population.
Because MDR TB is resistant to at least two of the main TB drugs, antibiotic treatment for more resistant cases can cost up to $300,000 per patient. Although the health department had not yet received results from a second round of testing, public health epidemiologists estimated that Sheboygan could find as many as 15 symptomatic MDR TB cases and 200 additional latent cases, which would require nurse-supervised antibiotic treatment for six months to a year. Interruptions in latent TB treatment could result in the development of MDR TB.
Sheboygan County sought millions in supplemental state funding to cover the cost of the public health response.