Refugees undergoing treatment for contagious TB in Vermont

This article by Bruce Parker originally published July 1, 2016, on Watchdog.org.

Medical professionals from University of Vermont Medical Center are treating refugees for contagious active tuberculosis, according to documents Watchdog obtained through a public records request.

The TB control team, which is administering drug treatments to stop the spread of the deadly disease, consists of public health nurses, infectious disease doctors and microbiologists associated with the Vermont Department of Health’s Refugee Health Program.

Tuberculosis is one of the world’s most deadly infectious diseases. Caused by the bacterium Mycobacterium tuberculosis, TB typically attacks the lungs and is transmitted by coughing, sneezing and saliva. Active TB disease, unlike its latent counterpart, is contagious, symptomatic and even fatal if not treated properly.

In Health Department documents redacted to conceal refugees’ names and country of origin, one patient, who began treatment on Dec. 31, was diagnosed with extrapulmonary tuberculosis — meaning symptoms are affecting organs other than the lungs. Public health nurses have been administering treatment around the patient’s work schedule, said to be three days a week.

The patient’s disease is susceptible to standard drug treatment, according to the documents. Standard drug therapy for tuberculosis involves giving the patient six to nine months of antibiotics, including isoniazid, rifampin, ethambutol and pyrazinamid. The regimen costs about $17,000 per patient, according to the Centers for Disease Control and Prevention.

Two of the patient’s family members also tested positive for TB, but it’s unclear from the documents whether their infections are latent or active.

Another active TB disease patient, who received her first treatment on April 25, experienced the trademark chest pain and cough associated with pulmonary tuberculosis. The patient’s husband and child also tested positive for tuberculosis, but it’s unclear from the documents whether their infections are latent or active.

As seen in the emails, field nurses are the first line of defense in Vermont’s tuberculosis control effort. They schedule regular appointments, coordinate weekly doses, assess symptoms and report findings to infectious disease doctors at UVM Medical Center in Burlington.

They also show broad flexibility, providing treatment from health offices and in homes, or even in cars — as was necessary on occasion to comply with patients’ work schedules. Nurses also provide refugees with bus passes, food cards and taxi vouchers.

In one exchange, on April 25, nurses appear worried about their contagious patient’s mobility. The patient is preparing to take a child to the dentist, and the nurses, who wear N95 respirator masks in the early treatment phase, fret about public safety implications.

“If we are wearing N95s should she be going out to this office?” the nurses ask.

After elevating the matter to infectious disease doctors, Wallace Kemper Alston, an infectious disease doctor with the University of Vermont Medical Center Infectious Diseases Unit, responds, “I feel her transmission risk is low, but she is somewhat compromised with lupus on low dose prednisone … I think it would look bad to be in dentist’s waiting room.”

Other sticky situations arise as the health professionals discuss getting patients to and from appointments. “So if we can get her a mask would getting there via bus be OK if that’s what she needs to do?” the nurses ask.

While contact investigations focused on the patients’ contacts with immediate family, some discussions open up the possibility that the nurses should broaden investigations to identify others who may have had contact with diseased patients.

Who pays for treatment isn’t detailed in the records. However, an informational flier with a comment about Vermont Health Connect says “refugees can get medical coverage because they can get a temporary social security number and temporary Medicaid card.” The flier adds that “there are no issues with getting prescriptions from pharmacy.”

Last month, Watchdog reported that 35 percent of Vermont’s refugees test positive for tuberculosis. While the vast majority of cases aren’t contagious and show no symptoms, the new Health Department documents provide the first glance into the state’s treatment of refugees with active TB disease.

At least seven other states have discovered active TB disease among resettled refugees, Breitbart reports. While Health Department statistics show that native Vermonters experience about five active TB cases each year — out of 630,000 residents — refugee populations experience a higher rate of incidence.

Fears about tuberculosis are on the rise, as the World Health Organization has warned of a global crisis of drug-resistant forms of tuberculosis, and a new study claims that 2 million children worldwide have the strain.

While standard tuberculosis drug treatment costs about $17,000 per patient, the CDC says the cost of treating multidrug-resistant tuberculosis (MDR) and extensively drug-resistant tuberculosis (XDR TB) averages $134,000 and $430,000 per patient, respectively.

Medical center doctors conducted testing to find drug-resistant forms of TB, but the strains responded to standard antibiotics regimens, according to the documents.

Although records blacken out the refugees’ country of origin, one document notes that Vermont received refugees from from Bhutan, Somalia and Democratic Republic of the Congo in 2015.

News of the TB control effort comes as Rutland is preparing to accept 100 Syrian refugees through the Vermont Refugee Resettlement Program. The decision to accept refugees was made in secret by Rutland Mayor Chris Louras, sparking outcries from Vermonters across the state.

Residents of Rutland have advanced a petition to vote on the issue, but Louras said letting residents vote on the issue is “offensive.”

The Vermont Health Department’s public records may be read here online.

Image courtesy of Public domain
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