Substance use patterns in a tuberculosis outbreak in Jackson County, MS, 2005 – 2007

Background: Tuberculosis (TB) rates are higher among substance users than the general population. With an estimated 22.6 million Americans classified with substance dependence or abuse annually, understanding the relationship between substance abuse and TB has public health importance. We investigated the role of substance use among a cluster of TB patients in Jackson County, Mississippi in 2007.

Methods: We included TB patients reported in Jackson County from December 2005–November 2007 having matching genotypes or epidemiological links to patients with matching genotypes. We interviewed patients, reviewed medical records, identified, and evaluated TB contacts, and assessed transmission sites.

Results: Eleven TB patients were included. All were African American, 9 (81%) were male and 10 were adults (>15 years). Among 10 adults, 6 (60%) reported excessive alcohol intake; 3 (30%), recreational prescription pain medication use; 7 (70%), cigarette smoking; and 6 (60%), marijuana smoking. Among 8 adults with a history of incarceration, 3 patients were arrested for drug- or alcohol-related offences. Epidemiologic links between patients included substance use in environments conducive to transmission, such as smoking marijuana in closed vehicles. Substance-using patients were reluctant to name at-risk contacts and seek care for symptoms. Among 170 community contacts, 42% had positive tuberculin skin test results.

Discussion: Substance abuse was prevalent in this population, fueled transmission, and created barriers to TB control. Addressing TB in this population requires increasing community collaboration and education, establishing and maintaining rapport and trust, and employing unique strategies to identify cases and contacts in hard-to-reach groups.