Federal agency probes TB among local meth users

A national health team is investigating a tuberculosis outbreak among methamphetamine users in Snohomish County.

The Snohomish Health District requested the assistance of the Centers for Disease Control and Prevention (CDC) about two weeks ago. The CDC sent a three-person team from its outbreak-investigations branch and its international-research-and-programs branch.

Health-district officials learned in August of one case of tuberculosis involving a methamphetamine user. By December, the number had grown to four. Now, nine patients appear to have been infected with a similar strain.

Three of the nine cases have been linked through epidemiology and genetic research.

The common denominator among all nine is their shared methamphetamine use, which would have brought them into close enough contact for TB exposure, officials say.

Health-district officials believe they are catching up with the spread of the disease because recent patients have been less sick than those initially brought to the district's attention, said Donna Allis, the district's tuberculosis-program manager.

But the need for CDC assistance signals the difficulty that local health agencies can have when working within the drug population, she said. The Snohomish Health District said it had requested help because of the federal agency's work with similar outbreaks among drug users, including a recent TB outbreak among meth users in Indiana.

"The CDC is helping us link cases in different ways," said Dr. Ward Hinds, the health district's medical officer. "The majority of TB cases here are usually found in people born outside the United States or those that contracted it outside the United States. This is a different dynamic."

The health district's main goals with TB cases are to treat infected patients and stop further spread of the disease through the use of antibiotics.

Because TB is an airborne infection, local health workers need access to patients' families and friends. Within the meth-user population, as well as other drug populations, patients aren't always forthcoming with such information, local and CDC officials said, making it difficult to track the disease's spread and end an exposure cycle.

Often, patients won't give names of acquaintances for fear of police investigation or retribution from drug dealers. Local nurses working on Snohomish County cases often have to locate other potential victims through nicknames. The health district does not turn information over to law-enforcement officials.

"Only one thing works in getting such patients to help, and that's to gain their trust," said John Oeltmann, a CDC epidemiologist. "Until that happens, you get nowhere with these groups of people."

There is also an issue of homelessness within the Northwest's meth population, which makes it more difficult to find others exposed to the disease or to treat confirmed cases, Hinds said.

The health district could ask the courts to order someone to be medicated, but that is considered an ineffective method, and the district has done so only a couple of times in about 15 years, Hinds said.

Instead, the district is helping at least two of the nine patients with housing, putting them up at motels. Hinds said that often is the best way to ensure homeless patients can be contacted for continuing care.

"The intensity and length of treatment of six to nine months needs to be continuous to be effective, so that we do not end up with a resistant strain," Hinds said.

Snohomish County's outbreak of TB-infected meth users will be one of only a few case studies available.

"This is as much a learning experience for us," said Eric Pevzner, an epidemic-intelligence officer for the CDC.

Christopher Schwarzen: 425-783-0577 or cschwarzen@seattletimes.com