Foreign-born are hardest-hit as cases of TB soar in county

Tuberculosis cases in King County this year have doubled compared with the same period last year, and health officials say foreign-born residents with the disease are having a significant impact.

Because the disease is well-monitored, authorities don't think there is an imminent threat of increased spread to other parts of the community. But they say they're swamped with work as they try to manage the disease.

"We need more help," said Dr. Masa Narita, director of TB control for Public Health — Seattle & King County.

From January through March, 38 TB cases were reported, compared with 18 in the same period last year. In 2006, the annual total was up 16 percent from 2005 — to 145 cases, with 80 percent of the patients foreign-born.

"It is concerning, and we have to continue the thorough job we're doing with case management and timely ... investigations," Narita said.

The proportion of TB patients who are foreign-born has increased from 68 percent in 2003. That has paralleled immigration increases in King County since 2002 from regions where TB is widespread: Eastern Africa (immigration up 95 percent since 2002), Central America (up 47 percent) and Southeast Asia (up 18 percent).

Worldwide, about a third of the population is infected with TB, including an estimated 100,000 people in King County who carry inactive TB bacteria, according to Public Health and the federal Centers for Disease Control and Prevention (CDC). Each year, nearly 9 million people worldwide become sick — develop active TB — and they can spread the bacteria through coughing. Nearly 2 million die of TB annually.

Public Health's TB-control staff oversees all new cases, including watching many patients take their medication to ensure the disease is stopped and doesn't spread. And staff members interview more than 2,500 people who are in close contact with newly infected people to make sure they don't have symptoms.

Full treatment typically costs $7,000 to $9,000 per patient. But about two patients a year in King County are resistant to the two most common drugs for the disease, as are about 125 patients nationally. Those patients need up to two years of treatment instead of the usual six to nine months, and it can cost up to $250,000 each.

Funding for county TB efforts has increased from more than $3.4 million in 2005 to $4.1 million for 2007, including local, state and federal money. The increases have included a rise from $780,000 in 2005 to $877,000 this year to help control an outbreak of TB in the homeless.

That outbreak began in 2002 with 30 cases, which pushed the annual total that year to 158 cases, a 30-year high. The homeless cases had decreased to 16 last year.

Program improvements have included establishing nurse-outreach worker teams for patient care and working more with public and private clinics to increase direct observation of medication-taking. Screening contacts of new patients also has improved.

But Narita said the program needs more staff and money to control the disease. Public Health, the King County Board of Health and the King County Executive's Office are looking for ways to do that.

Some experts complain that immigrants and visitors to the U.S. are insufficiently screened for TB before they leave their homelands. X-rays to detect the disease are used only on refugees, people seeking permanent-resident "green cards" or those suspected of having active TB. Yet even then, X-rays can be outdated by the time the patients reach the U.S., said Kim Field, director of the state Department of Health's TB program.

In Seattle, a 58-year-old former Boeing engineer from Vietnam was diagnosed with TB in January. He said he thinks he contracted the disease in his homeland more than 30 years ago. But it took many tests before the disease finally was diagnosed in tissue around a severely weakened vertebra, which had broken when he sneezed hard and fell down in pain.

Now the man, who asked to remain anonymous, is not contagious. But because he is resistant to one drug and allergic to another, he will be under treatment for up to a year.

"I'm getting better, but it's going to be a long time for me," he said. "It [the diagnosis] has been a total shock to me."

Warren King: 206-464-2247 or wking@seattletimes.com