Palm Beach Post (10.14.12)
A tuberculosis (TB) outbreak in Florida, labeled the worst in the nation in 20 years, appeared to flourish as state and federal health officials placed political concerns and protocol above alerting the general public about the outbreak, documents and interviews show. The Palm Beach Post has obtained more than 4,000 emails spanning 2009 to mid-2012 between staff at the Florida Department of Health and the U.S. Centers for Disease Control and Prevention (CDC) showing how the disease outbreak became secondary to Florida Governor Rick Scott’s staff agenda to downsize and privatize much of the department. The emails portray CDC staff as consistently deferring to health department staff even as CDC’s concerns about the handling of the outbreak grew. Months after CDC recommended announcement text to warn the general public about the outbreak, the news of the outbreak remained undisclosed.
Documents revealed that in Duval County, health officials were only selectively following CDC’s advice after its first investigation of TB in 2008 and 2009 because of aggressive spending cuts to public health spending by state legislators. Now, a second TB outbreak in three years has surged from 10 cases to 30 within a year. The CDC’s term for its intensive outbreak investigations is “Epi-Aid,” two of which have taken place in Jacksonville since 2008–2009. In both cases, CDC called for all of the sick and their close contacts to be tracked and treated. The Duval County Health Department currently has no epidemiologist or data manager focusing on TB issues, although these positions had been recommended and funded after the 2009 Epi-Aid.
On July 8, the Post ran a story detailing the situation, and a 25-page Epi-Aid report, written by Epidemic Intelligence Service Officer Dr. Robert Luo, was circulated among lawmakers and the governor’s staff. Four days later, state Surgeon General Dr. John Armstrong activated an incident command to address the TB problem, marking a 180-degree turn in how the state handled the outbreak. More than 1,400 potentially exposed individuals have been located by health officials—nearly six times the number found in the previous two years. The health department now holds weekly media calls that supply a running count of the agency’s progress on containing the Jacksonville cluster, where 82 percent of the latent TB cases are now undergoing treatment.
Florida had 753 cases of TB in 2011. To date in 2012, there have been 410 cases, a decrease of 143 from the same period last year.