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Largest TB Outbreak in Decade Among Homeless in Los Angeles Largest TB Outbreak in Decade Among Homeless in Los Angeles
Despite the overall declining number of cases of tuberculosis (TB) across the country it is on the rise among the homeless. Just last... Largest TB Outbreak in Decade Among Homeless in Los Angeles

by Kimberly Allen, RN

Despite the overall declining number of cases of tuberculosis (TB) across the country it is on the rise among the homeless.  Just last month, the Centers for Disease Control sent a group of scientists to Los Angeles to assist local officials with what they are calling the largest TB outbreak in over a decade.  Health officials state that 11 people have died from this particular strain of TB since 2007.  Most of the cases of TB were found amid the homeless people living on and around skid row.  Recently scientists connected a strain of TB that is exclusive to Los Angeles with the current outbreak.
homelessHealth officials are currently looking for approximately 4,650 people that believed to have been exposed.  Anyone that may have been exposed to TB should be tested and if necessary receive treatment .  Officials are concerned because most of the cases are connected to a very vulnerable group of people in a fairly small geographic area.  However, there is a significant risk of it spreading to other areas.
Homeless people are vulnerable to a wide variety of health issues including contracting diseases like TB.  The things that make them so vulnerable are that in addition to poor hygiene and nutrition, they have ongoing contact with people that are infected and only limited access to health care.  The homeless also live in over crowded areas like shelters.  The homeless are also transient tending to move about the streets and among the hospitals.  many homeless are also suffering from mental illness and/or substance abuse which can make them fearful of seeking treatment.  All these factors worry officials that the outbreak could spread to other areas.
TB or tuberculosis spreads easily, just like the flu or a cold.  The TB bacteria is carried in the tiny droplets that are expelled when you cough and/or sneeze, even when you laugh or sing.  also, a person can be a “carrier” of TB but not have active disease for years.  Unlike the flu or cold viruses you can not get TB by touching someone like when shaking hands or even touching their clothes.  It is primarily spread through close person to person proximity when you breathe the air surrounding your immediate area.tuberculosis
TB primarily affects the lungs.  Once the bacteria are inhaled they enter the lungs and multiply usually causing pneumonia.  Though TB starts in the lungs it can spread to other areas of the body.  In most people, the body’s immune system would be able to prevent the infection, however the immune systems of the homeless are compromised leaving them vulnerable to the disease spreading throughout their body as well.
Because the TB bacteria start their dirty  work in the lungs the symptoms of TB are similar to a respiratory infection.  Symptoms may not develop for months or longer after exposure.  However, someone with active TB will complain of overall weakness and fatigue with a fever and night sweats.  many experience a noticeable weight loss also.  As the infection worsens the coughing becomes severe and you will also start to cough up blood and/or sputum.  Most also complain of chest pain and shortness of breath.
Left untreated TB can be fatal.  Public Health officials state that they are putting as many resources as possible into locating all those people that have been exposed to test them and initiate treatment as well as contain the current outbreak which has been declared an epidemic.  The strain of TB currently affecting the homeless in Los Angeles can be treated with all anti TB medications including Isoniazid, Refampin and Ethambutol.  Treatment with one or more of these medications usually lasts 6 to 9 months.  All emergency rooms as well as clinics and urgent care centers have already been put on alert by the Public Health Department and are actively watching for anyone that may have symptoms of TB.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at