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Source: http://www.theglobeandmail.com/servlet/story/LAC.20080901.BCTUBERCULOSIS01/TPStory/National
Tuberculosis outbreak may take five years to contain
SHANNON MONEO
Special to The Globe and Mail
September 1, 2008
VICTORIA -- It may take up to five years to squelch a tuberculosis outbreak that has plagued the central Vancouver Island community of Port Alberni since late 2005 when a homeless, mentally ill addict was identified as having the disease.
His was the first of what grew into 40 TB cases.
"People who are homeless, who have mental illness, may go back to areas where they can get re-infected," said Lorna Medd, medical officer for the Vancouver Island Health Authority.
The treatment for the disease involves regularly taking several types of pills for six to nine months. Once a person is cured, they can get re-infected if their immunity is low and they are exposed to the TB bacteria.
Of the 40 confirmed cases, most have occurred amongst the Nuu-chah-nulth people who live in the Alberni Valley. Aboriginal people, on and off reserves, continue to be the focus in the bid to stop the current "major outbreak," Dr. Medd said. But she stressed that this latest TB scare is "not about ethnicity, it's about social determinants of health."
The underpinnings are disenfranchisement, homelessness, drug and alcohol addictions and mental illness, Dr. Medd said from Nanaimo.
When someone with infectious TB coughs or sneezes, those nearby can catch TB by breathing in the germs, which attack the lungs and other areas of the body.
Those with compromised immune systems are more likely to go from having TB infection to full-blown TB disease, signs of which may include chest pain, coughing, shortness of breath, loss of appetite, weight loss, fatigue, fever and night sweats.
According to a report prepared by Kevin Elwood, director of tuberculosis control at B.C. Centre for Disease Control in January, 2007, Port Alberni's TB infection was spread in a Port Alberni hotel, as well as crack houses and alleys.
In 32 cases, the infected range in age from 15 months to mid-70s and reside in the Alberni Valley, while the remaining eight live outside the area but had contact with a valley resident.
Four of the TB victims died, but Dr. Medd said their deaths were "lifestyle-related." Since May, 2007, there have been seven new cases. The average per year for the area is five.
Nuu-chah-nulth Tribal Council President Tom Happynook said if it wasn't for the work done by Nuu-chah-nulth health services staff, the Alberni TB outbreak could have been worse.
"The outbreak is serious. It has had a big effect on our people. Our NTC health service staff gave it a high priority," he said.
While the TB outbreak was first detected more than two years ago, Mr. Happynook said that it's been only in the last year that the regional health authorityVIHA has ramped up its response.
The tribal council, which represents about 8,000 people from 14 first nations, used a dedicated two-person TB team along with about 20 more nurses and health-care workers, who have gone into the community to find people suffering from TB.
"Our staff know where our people are living. Our people are far more comfortable reaching out to our staff," Mr. Happynook said.
The Vancouver Island Health Authority, which uses rigid health-care policies, has a lot to learn from the tribal council's health department, Mr. Happynook said.
"I hope VIHA is open to building a strong relationship to provide services our people need, no matter where they live. It's important for them to support goals and objectives we have as opposed to trying to impose their goals and objectives on us," he said.
VIHA and the Nuu-chah-nulth have been working closely to combat the TB outbreak and VIHA will continue to be sensitive to the needs of its clients, Dr. Medd said.
To improve the relationship, a community and cultural co-ordinator will be jointly hired this fall by VIHA and the Nuu-chah-nulth to work with a scientific outbreak co-ordinator.
Since the TB outbreak, the town of Port Alberni has also been spurred to develop a plan to eliminate homelessness and improve health-care accessibility.
About 90 per cent of people who are exposed never develop TB disease, Dr. Medd said. If they're healthy enough, their bodies build walls around the TB germs, in effect imprisoning the bacteria within the body.
The Bacille Calmette-Gu?rin vaccine was given to health-care workers in B.C. until the mid-1970s.
In the 1990s, the Nuu-chah-nulth stopped using the vaccine because it does not provide sufficient protection, Dr. Medd said.
By 2003, all first nations communities in B.C. discontinued BCG use.
Tuberculosis outbreak may take five years to contain
SHANNON MONEO
Special to The Globe and Mail
September 1, 2008
VICTORIA -- It may take up to five years to squelch a tuberculosis outbreak that has plagued the central Vancouver Island community of Port Alberni since late 2005 when a homeless, mentally ill addict was identified as having the disease.
His was the first of what grew into 40 TB cases.
"People who are homeless, who have mental illness, may go back to areas where they can get re-infected," said Lorna Medd, medical officer for the Vancouver Island Health Authority.
The treatment for the disease involves regularly taking several types of pills for six to nine months. Once a person is cured, they can get re-infected if their immunity is low and they are exposed to the TB bacteria.
Of the 40 confirmed cases, most have occurred amongst the Nuu-chah-nulth people who live in the Alberni Valley. Aboriginal people, on and off reserves, continue to be the focus in the bid to stop the current "major outbreak," Dr. Medd said. But she stressed that this latest TB scare is "not about ethnicity, it's about social determinants of health."
The underpinnings are disenfranchisement, homelessness, drug and alcohol addictions and mental illness, Dr. Medd said from Nanaimo.
When someone with infectious TB coughs or sneezes, those nearby can catch TB by breathing in the germs, which attack the lungs and other areas of the body.
Those with compromised immune systems are more likely to go from having TB infection to full-blown TB disease, signs of which may include chest pain, coughing, shortness of breath, loss of appetite, weight loss, fatigue, fever and night sweats.
According to a report prepared by Kevin Elwood, director of tuberculosis control at B.C. Centre for Disease Control in January, 2007, Port Alberni's TB infection was spread in a Port Alberni hotel, as well as crack houses and alleys.
In 32 cases, the infected range in age from 15 months to mid-70s and reside in the Alberni Valley, while the remaining eight live outside the area but had contact with a valley resident.
Four of the TB victims died, but Dr. Medd said their deaths were "lifestyle-related." Since May, 2007, there have been seven new cases. The average per year for the area is five.
Nuu-chah-nulth Tribal Council President Tom Happynook said if it wasn't for the work done by Nuu-chah-nulth health services staff, the Alberni TB outbreak could have been worse.
"The outbreak is serious. It has had a big effect on our people. Our NTC health service staff gave it a high priority," he said.
While the TB outbreak was first detected more than two years ago, Mr. Happynook said that it's been only in the last year that the regional health authorityVIHA has ramped up its response.
The tribal council, which represents about 8,000 people from 14 first nations, used a dedicated two-person TB team along with about 20 more nurses and health-care workers, who have gone into the community to find people suffering from TB.
"Our staff know where our people are living. Our people are far more comfortable reaching out to our staff," Mr. Happynook said.
The Vancouver Island Health Authority, which uses rigid health-care policies, has a lot to learn from the tribal council's health department, Mr. Happynook said.
"I hope VIHA is open to building a strong relationship to provide services our people need, no matter where they live. It's important for them to support goals and objectives we have as opposed to trying to impose their goals and objectives on us," he said.
VIHA and the Nuu-chah-nulth have been working closely to combat the TB outbreak and VIHA will continue to be sensitive to the needs of its clients, Dr. Medd said.
To improve the relationship, a community and cultural co-ordinator will be jointly hired this fall by VIHA and the Nuu-chah-nulth to work with a scientific outbreak co-ordinator.
Since the TB outbreak, the town of Port Alberni has also been spurred to develop a plan to eliminate homelessness and improve health-care accessibility.
About 90 per cent of people who are exposed never develop TB disease, Dr. Medd said. If they're healthy enough, their bodies build walls around the TB germs, in effect imprisoning the bacteria within the body.
The Bacille Calmette-Gu?rin vaccine was given to health-care workers in B.C. until the mid-1970s.
In the 1990s, the Nuu-chah-nulth stopped using the vaccine because it does not provide sufficient protection, Dr. Medd said.
By 2003, all first nations communities in B.C. discontinued BCG use.