Board of Health expands screening, proposes plan to eliminate tuberculosis from Mahoning County
Mahoning County has seen a rise in tuberculosis cases in the past year. There were 10 TB cases confirmed in 1996, a nearly 100 percent increase over the number reported in 1995. "Ten doesn't sound like a lot, but for a community this size, it is excessive", says health commissioner Matthew Stefanak.
Shortly after taking control of the TB program in 1993, the Board of Health's TB advisory committee published a plan for eliminating TB from Mahoning County by the year 2010. The advisory committee foresees reaching an interim rate of no more than 1.5 TB cases per 100,000 population by the year 2000. In 1996, the TB rate for Mahoning County was 3.8 cases per 100,000 population.
The plan describes four strategies for TB elimination: surveillance, case prevention, disease containment and program evaluation and assessment. Experts at the U.S. Centers for Disease Control and Prevention believe that eliminating TB will require local programs to improve their activities in each of these four areas.
TB staff provide outreach education to the public and professional community by sending TB updates to physicians, nursing home administrators and drug abuse counseling centers. Screening for persons with high TB risk is an important surveillance activity. In 1996, TB staff gave 2,579 TB skin tests to nursing homes employees, students, case contacts, homeless shelters residents, substance abuse treatment centers clients, and residents of other long-term care facilities. This reflects a 15 percent increase over the number screened in 1995. About two percent of persons screened in 1996 had evidence of TB infection, a figure that health officials say is about average for most communities.
Improving Case Prevention:
To prevent TB from spreading further, close contacts of suspected TB cases are evaluated within 30 days. If found to be infected with TB, many of these contacts receive up to nine months of drug treatment to prevent them from developing active TB in the future.
Improving Disease Containment:
Disease containment can prevent further transmission of the disease in the community. Because TB treatment is lengthy - up to nine months - and the medication sometimes produces unpleasant side effects, many patients do not complete their treatment unless they are monitored by public health workers. Following CDC and American Thoracic Society recommendations, all active TB cases in Mahoning County are treated with directly observed therapy (DOT), a strategy that requires TB staff to observe patients taking their medication in the clinic or at home. DOT was started for 17 individuals in 1996.
Program Evaluation and Assessment:
TB staff consult regularly with local experts on the Board of Health advisory committee and the Ohio Department of Health to get feedback on the program's effectiveness. The true measure of its effectiveness, TB staff believe, will be a reduction in the number of TB cases in the years ahead.
Mahoning County's TB program is funded through a 0.1 mill tax levy which expires at the end of 1997. Health officials are expected to push for levy renewal to maintain current TB elimination efforts.