Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017

Abstract

In 2008, an outbreak of isoniazid-resistant tuberculosis was identified among residents of homeless shelters in Atlanta, Georgia, USA. When initial control efforts involving standard targeted testing failed, a comprehensive approach that involved all providers of services for the homeless successfully interrupted the outbreak.

Public Health Response to Tuberculosis Outbreak among Persons Experiencing Homelessness, Minneapolis, Minnesota, USA, 2017–2018

“…Despite our comprehensive approach to treating new cases of LTBI, treatment completion was low overall, a challenge not unique to this study (20,21). Although our work can inform contact identification, prioritization, and screening methods, unless LTBI treatment completion rates improve, which requires intensive resources, we expect to see a continuation of this TB cluster in Hennepin County in the PEH population.…”

Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA

“…[21] As at December 2017, a total of 110 TB cases in the county have been linked to this outbreak. [22] In the report by Powell et al , the epidemiological curve of this outbreak was described in three phases–initial phase when only one facility was involved (2008–2009), quiescence phase when cases waned (2010–2013) and the recrudescence phase when multiple facilities became involved (2014 and thereafter). [21,22] A full description of the epidemiology of the associated cases and the outcomes of the direct contact tracing are well documented in prior studies.…”

“…[21,22] A full description of the epidemiology of the associated cases and the outcomes of the direct contact tracing are well documented in prior studies. [21,22]…”

“…Following the resurgence of the outbreak in 2014, several county-wide outbreak control measures were instituted. [21,22] One of these measures was the implementation of mandatory TB screening in all Atlanta homeless housing facilities in May 2015. [21,22] Prior to this, outbreak-related TB screening services were only provided onsite at the Fulton County health department or at sporadic intervals on mobile units sent out to the affected shelters.…”

“…Each shelter user was expected to get screened for TB within 7 days of initial shelter entry and every 6 months thereafter to guarantee continued access to any of the shelters. [22] Both onsite (TB clinic) and offsite (shelter locations) TB screenings were performed using either tuberculin skin test (TST) or an interferon gamma release assay method (QuantiFERON Gold-in-tube tests (QFT)). [21,22] Homeless persons who tested positive for TB infection either through TST (>10mm induration) or QFT were referred to the health department for clinical evaluation.…”