San Diego County works to address increasing number of tuberculosis exposures


Hannah Saunders


San Diego County is working to address tuberculosis (TB) exposures at several program sites of Father Joe’s Villages, an organization that works to support the homeless population. Dates of potential TB exposures range from Jan. 14th to March 3rd. 

Father Joe’s Villages told State of Reform that from January to March, a client with an active TB case utilized the organization’s services, creating a potential exposure to employees, clients, and the community. 

“The health and safety of our staff, volunteers, and clients is paramount,” said Dr. Jeffrey Norris, chief medical officer at Father Joe’s Villages. “Father Joe’s Villages is working with our partners at the County of San Diego to take the necessary steps to notify staff, clients and others who may have been exposed. We will also be working to provide clients with the treatment necessary to treat any TB infections.”

TB is an airborne disease that is transmitted from person-to-person through the inhalation of bacteria in the air. When an individual is ill with TB and coughs, speaks, sings, or breaths, the bacteria spreads in the air. 

Two tests are used to detect TB: the TB skin test and TB blood tests. According to the CDC, a positive TB test result can only detect whether a person has not been infected with TB bacteria, and does not detect whether a person has a latent TB infection or progression towards TB disease.

Officials from the Tuberculosis Control Program under San Diego County’s Health and Human Services Agency (HHSA) are working closely with officials from Father Joe’s Villages to notify staff members, volunteers, and clients who were potentially exposed.

“The County’s TB Control Branch has an outreach and education team that has already begun direct outreach to persons experiencing homelessness in areas surrounding Father Joe’s Villages, and will continue outreach activities over the coming weeks,” Cassie Klapp, communications officer for the San Diego HHSA, told State of Reform.

Klapp also stated that if individuals are experiencing active TB symptoms, such as a cough lasting over three weeks, unintentional or unexplained weight loss, night sweats, or a persistent fever, they should go to a hospital or contact TB control immediately. 

“The TB Control program is able to provide services to people with low-income or those who may be uninsured or underinsured,” Klapp said. “The program ensures that all person[s] with active TB in San Diego County receive treatment and facilitates the care for people with active tuberculosis through services potentially including direct medical care, supportive consultation for other treating physicians, nursing care management, social work assistance, pharmacy assistance, and housing and transportation support.”

Impacted Father Joe’s Villages facilities include the Inclement Weather Shelter, San Diego Day Center, Food Services, Employment and Education Services, and Village Health Center. The day center provides a safe place for individuals to rest during the day, and offers essential resources like restrooms, storage facilities, showers, laundry, mail, phones, and access to employment and educational resources.

Each day of the year, Father Joe’s Villages provide hot meals to those experiencing homelessness under the Food Services program. Their Villages Health Center offers primary care, dental care, behavioral healthcare, psychiatry, and addiction treatment. The Employment and Education Services program allows individuals to access computer labs, phones, employment classes, expert staff, and additional resources.

Individuals experiencing homelessness are at an increased risk for TB due to challenges with accessing healthcare, a higher risk of getting infected in congregate settings, as well as having certain medical diagnoses that may be more common and severe among those experiencing homelessness. 

San Diego County’s TB Control Branch is hosting TB screening events in the near future to ensure access to screening services such as TB blood and skin tests, and chest x-rays to individuals without other access to screening services. Klapp said that the TB Control Branch will link individuals with active TB infections to additional services to determine whether they have a contagious active TB disease, or non-contagious and asymptomatic latent TB infection.

Since 2021, San Diego County has seen a slight uptick in TB cases, with a total of 201 active TB cases being reported in that year, and 208 active cases reported in 2022. HHSA estimates that 85% of active TB cases from 2022 were due to the progression of longstanding latent TB infection that progresses to active TB. The areas with the greatest number of cases and incident rates for 2022 were in the south and central regions of the county. 

Further agency data shows that 67% of TB cases from 2022 occurred in individuals who were born outside of the United States, and that of the 69 TB cases that involved individuals born within the United States, 78% or 54 cases involved Hispanic individuals. 

In 2022, cultures were taken from 175 of the confirmed TB cases, and genotyping results showed that 13%, or 23 cases, had disease that was attributed to Mycobacterium Bovis, which is also known as bovine TB. This form of TB generally comes from consuming unpasteurized dairy products. 

While the BCG vaccine is used in some countries, it is not regularly used in the US because it only has minimal protection against TB, according to Klapp. 

“It is most effective at reducing certain forms of severe TB in young children,” Klapp said. “People who received the BCG vaccine as children are not fully protected against getting sick from TB, and any limited protection wanes substantially during adulthood.”

Familiarizing oneself with risk factors of TB is an important step towards preventing the disease. Those who have contact with a person known to have TB, have experienced homelessness or incarceration, or frequent and extended travel outside of the US, are several risk factors for TB. Klapp said that those with latent TB infections have a 5-10% chance—without treatment—of getting sick from active and contagious TB in the future. However, antibiotics can cure latent TB infections in 12 weeks and can prevent people from getting TB in the future.

“While situations where someone has active TB gets the most attention, 175,000 San Diegans are estimated to have latent TB infection, and could develop active TB in the future,” Klapp said. Only about 25% of them know it, and only about 15% have taken preventive treatment.”

Klapp added that the most effective strategy to eliminate TB in San Diego County is for individuals to know and understand their risks for TB infection, get tested, and take preventive treatment if they are found to have a latent TB infection.