More than 1,000 tested for TB in rural Alabama
Marion, Ala. – — Tuberculosis, a global scourge, has mostly been eradicated in the United States, but minorities and poor people who lack regular health care remain vulnerable.
Marion, the town where Coretta Scott King was raised, is just that kind of community: the seat of Alabama’s poorest county, where 47 percent live in poverty and the per-capita annual income is just $13,000.
Spurred by two tuberculosis deaths last year, Alabama public health officials tried reaching out in Marion, and were mostly ignored or turned away. Many people seemed suspicious and unenthusiastic about providing blood samples to the government. Efforts in late 2014 to trace the contacts of people who did test positive were stymied; few in the town of 3,600 seemed eager to tell on their neighbors.
“We had a very, very poor turnout. Our turnout was so bad, we actually had people throwing beer bottles at us,” said Pam Barrett, director of the Alabama Department of Public Health division for tuberculosis control.
The U.S. Centers for Disease Control and Prevention has long called for targeting the fight against tuberculosis where the disease remains most prevalent, among poor and minority populations. The airborne bacterial infection spreads when people live in unhealthy conditions in close proximity and get little health care. Blacks and Hispanics are eight times more likely to carry it than whites are.
“While most people think of TB as a disease that does not affect the U.S., Marion, Alabama is experiencing a TB outbreak that is worse than in many developing countries,” stated Eric P. Goosby, the UN Special Envoy on Tuberculosis, on Wednesday.
The deaths in 2015 and another in 2011 justified a more proactive response. Using grant money from the CDC, the local health department decided to pay $20 to anyone who comes in for a blood test, another $20 for returning three days later to get the result, an additional $20 for keeping an appointment for a chest X-ray if necessary, and $100 if a patient told to take medication completes the treatment.
The cash made all the difference: In the last two weeks, more than 1,000 people — a tenth of Perry County’s residents — have gotten tested, and public health officials found what they feared: an outbreak at a scale unseen in years. The tests showed that 20 people have had the disease since 2014.
Confirmed cases of tuberculosis disease reached a national low of 9,421 cases in 2014, or 2.96 cases per 100,000 people, according to the CDC. The tests in Marion uncovered an infection rate much higher than state and national norms.
Tuberculosis typically attacks the lungs and spreads when a person carrying the bacteria coughs, sneezes, speaks or sings and people nearby inhale the bacteria, according to the CDC. Symptoms include a persistent cough, chest pain, fatigue, weight loss and night sweats. But tuberculosis can live in the body without immediately making a person sick, and people with latent infections can’t spread tuberculosis unless their immune systems fail to control the bacteria.
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