In Los Angeles (LA), health officials and rescue mission leaders have begun a new, coordinated attack to suppress a persistent outbreak of TB in downtown LA’s skid row. They are searching for more than 4,500 people who may have been exposed to the disease. This unique type of TB has infected 78 people and killed 11. CDC has sent scientists to LA to help local health officials determine why the disease is spreading and how to stop it. Since 2007, 11 people have died. Sixty of the 78 cases were among homeless people who live in and around skid row. Scientists have recently linked the outbreak to a TB strain unique to LA, with a few isolated cases outside the area. Health workers are attempting to track down, test, and treat approximately 4,650 people who were probably exposed. Local and federal officials are particularly concerned because the cases are linked to one relatively small geographic area and one vulnerable population. If action is not taken, officials are concerned that the outbreak could spread beyond skid row. Homeless people are especially at risk of getting TB and of being undiagnosed because they have limited access to health care. They have poor hygiene and nutrition and continuing contact with infected persons. They also live in overcrowded areas and are constantly moving among shelters, hospitals, and the streets. Many homeless persons also have mental health or substance abuse issues that can hinder treatment. The skid row TB strain can be treated with all anti-TB medications. Treatment lasts six to nine months. The public health department recently disseminated an alert to clinics, urgent care centers, and emergency room doctors informing them about the investigation within the homeless community. According to the alert, most of the patients are men, and approximately 20 percent are also HIV-infected. Six of the eight patients who also had HIV have died. The health department issued new guidelines for shelters earlier this year about effectively screening and identifying patients at risk for TB, and recommended that shelters determine if incoming clients have been screened; if not, the shelters should refer them to health providers. The county suggests that all employees and volunteers be screened for TB because they are also at risk. As part of the ongoing investigation, the public health department recently sent a letter to shelters asking for information about all who have used their services.

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