March 24 is World Tuberculosis (TB) Day, and this year, the theme is Unite to End TB. We reached out to Dr. Joseph Iser, Chief Health Officer of the Southern Nevada Health District, which includes Las Vegas, to ask how his local health department fights the disease. We know that tuberculosis disproportionately affects communities of color and immigrant communities. We asked him to talk about how his office has successfully reached these populations in Las Vegas to fight against the spread of the disease.
By Joseph P. Iser, MD, DrPH, MSc
TB is one of the most deadly diseases in the world. TB bacteria usually grow in the lungs, but it can attack any part of the body such as the kidney, spine, and brain. The disease is spread from person to person through the air, and if not treated properly, it can be fatal.
TB continues to create challenges to health care workers, including new resistant strains and co-infection with HIV. The impacts of TB are felt all over the world; in 2005 TB killed 1.6 million people. It also poses significant challenges where I live and work, in Clark County, Nevada. In 2011 there were 85 new active cases of TB identified in Clark County, with approximately 800 residents receiving treatment for latent TB infection at any time. TB control remains an important element of public health intervention here, and because of this, we have a clinic dedicated solely to treatment, education, and investigation of this disease.
We know that TB does not affect all populations equally. The Centers for Disease Control and Prevention (CDC) reports that among U.S.-born people reported with TB disease, 39 percent were non-Hispanic blacks, a rate over seven times higher than the rate of TB disease in white, non-Hispanics. CDC statistics also show that Hispanics, the homeless, immigrants, and those living in correctional facilities are also disproportionately affected.
In Clark County, we reach out to these populations in a number of innovative ways. The Southern Nevada Health District partners with a local non-profit organization to expand testing in high risk groups in Clark County. The Health District has embraced technology and is able to conduct video directly observed therapy for high risk clients, ensuring compliance and the reduction of TB disease throughout the county. Additionally, the Health District conducts extensive county wide case investigations to find, evaluate, and, if needed, treat at risk individuals for TB disease.
Our coordinated, holistic efforts fight the disease effectively when TB is detected in a patient. When doctors, hospitals, or laboratories receive a positive tuberculosis test result, they are legally required to report it to the Health District. The TB Clinic contacts the patient to assess his or her need for treatment and provides assistance with community resources. For instance, public health nurses speak with and/or see each patient with active TB five times a week to verify that their food, shelter, and other needs are met. Then the public health nurse ensures proper treatment, which includes directly observing the patient taking their medication. In addition, the attending doctor examines adult patients weekly and pediatric patients monthly. Clinic staff members also conduct an extended field contact investigation to find people the patient has come in contact with so we can get them tested and treated for TB, if necessary.
The system works effectively and saves lives. In 2015, medical professionals in the Health District used their expertise to fight this disease one patient at a time. In one case, a 32-year-old Hispanic female had Type 2 diabetes and chronic back pain for one year before being diagnosed with Pott’s Disease, tuberculosis of the bone that weakens the bone structure. She had three spinal surgeries, two before the TB diagnosis. She was initially wheelchair bound, but since being treated in Clark County, she has been able to walk with a cane and gained 10 pounds.
Another case we are proud of is a 26-year-old Ethiopian female who presented to the emergency room due to nausea, vomiting, and abdominal distention. She was diagnosed with AIDS and peritoneal TB. She was gravely ill initially, but the TB and HIV nurse case managers worked very diligently to improve her condition significantly so she could go back to living a productive life. She was re-hospitialized twice and was seen by the Health District’s TB consultant. She started taking TB medications in September and has made remarkable progress. Originally 97 pounds, she has gained 40 pounds, and is able to perform activities of daily living independently.
Patient cases like these show that when a local health department puts a plan in place to connect at risk populations with the latest advances in medicine, lives can be saved, and patients can go on to thrive. This World TB Day, and every day, Southern Nevada Health District in Clark County is uniting to end TB by leveraging partnerships, targeting our efforts, and using cutting edge technology to support and heal those affected by the disease.