The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64063

Patrick K. Moonan, MPH¹, Manuel Bayona, MD, PhD², Teresa N. Quitugua, PhD³, Jospeh Oppong, PhD⁴, Gerry Burgess, BSN⁵, Nicole L. Hines, BSN⁵, Behzad Sahbazian, DO¹, and Stephen E. Weis, DO¹. (1) Department of Internal Medicine, Texas College of Osteopathic Medicine, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, 817-871-8914, pmoonan@hsc.unt.edu, (2) Department of Epidemiology, University of North Texas Health Science Center School of Public Health, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, (3) Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, 15355 Lambda Drive, San Antonio, TX 78245, (4) Department of Geography, University of North Texas, P. O. Box 305279, Denton, TX 75065, (5) Tuberculosis Elimination, Tarrant County Health Department, 1800 University Dr., Fort Worth, TX 76107

Tuberculosis is an important health problem among our nation’s homeless population. The homeless population has been identified to have an increased incidence of tuberculosis. This may be related to multiple factors that increase the risk of transmission including, overcrowding, malnutrition, and lack of access to care. Additionally, the high prevalence of alcohol abuse, intravenous drug use, psychiatric illness frequently found in this population creates barriers to diagnosis and treatment. As part of National Tuberculosis Genotyping and Surveillance Network, all culture confirmed cases in Tarrant County underwent molecular characterization for the detection and genotyping for specific strains of M. tuberculosis. A retrospective analysis of this genotyping data joined with geographic informational system (GIS) data demonstrated ongoing transmission is occurring in one small geographical area. Further analysis demonstrated that between January 1, 1993 and December 31, 2000, twenty-nine 29 cases identified living in the shelter were linked genetically using molecular genotyping techniques; another 9 cases were identified but did not match any other case. These discoveries led to an active surveillance program. Pre-requisite chest x-rays and tuberculin skin testing prior to regular residence in the shelter was implemented. Shelter residents must now undergo surveillance as a condition of living in the facility. Photo ID cards are issued to all participants. Residents must present the surveillance card to gain entry to the shelter and all of its services. The results of the implementation of pre-requisite TB screening will be presented. To our knowledge, this is the first time GIS analysis has been combined with genotyping of tuberculosis to design a targeting screening effort in tuberculosis control.

Learning Objectives:

• At the conclusion of the session, the participant will be able to:
• Identify risk factors contributing to ongoing transmission of TB in our nation’s homeless.
• Articulate the advantages of utilizing molecular characterization techniques in local TB control efforts.
• Articulate the utilization of GIS technology in local TB control efforts.
• Develop an active surveillance plan for screening homeless persons in congregate settings.

Keywords: TB, Homeless

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.