Tuberculosis and Homelessness: Not a Thing of the Past

In August, the Centers for Disease Control and Prevention held a meeting in Atlanta with several representatives from emergency shelters, health experts, federal officials, and national homeless organizations to discuss the spread of Tuberculosis (TB) in homeless shelter populations.

TB can be a fatal disease; it is transmitted through the air and can remain in the air for many hours, which means that people staying in crowded jails or shelters are especially susceptible. Not only do homeless people spend extended periods in crowded shelters, they’re more likely to have compromised immune systems from living on the streets.

There are 44 cases for every 100,000 persons in the homeless population compared to only 5 cases for every 100,000 persons in the general population, which is why this is a particularly important issue for homeless service providers to address.

Here’s some important information homeless service providers should keep in mind:

  • TB is not always fatal – There are two types of TB, latent or sleeping TB and active TB. Most latent cases of TB do not become active or deadly, if natural defenses kick in or medication is taken for long periods of time.
  • TB is curable – Curing TB requires extended regimen of treatment often in the form of taking many types of antibiotics over long periods of time, often up to six months. For people who are recovering from TB, housing is crucial, because without it maintaining treatment can be difficult. The medications must be taken strictly according to a schedule and can have adverse side effects.
  • TB is preventable – To prevent TB from spreading, providers must identify and monitor TB cases. In shelters, that means developing administrative, environmental and respiratory controls.

    • Administrative controls are the most effective and include regular TB screenings for shelter clients, training staff to identify potential cases, and monitoring coughing.
    • Environmental controls consist of having good ventilation, UV lighting or filters to remove contagions and policies to separate people with TB from the general population while they recover.
    • Respiratory controls include simple measures such as asking people to wear masks if they are showing symptoms.

What are the challenges and solutions for homeless service providers?

The incidence and prevalence of TB is relatively small. However, TB can be fatal, and it can spread easily. Outbreaks are happening in many cities, and it can take years to contain it.

Widespread screening can identify cases, but medication for treatment and the more intensive screening tools are not always easily accessible. For people undergoing treatment for TB, even people who aren’t homeless, just keeping up with the lengthy medication regimen and living with the stigma and isolation that comes from a diagnosis can be debilitating.

Many homeless service providers are already engaging in practices that are consistent with the prevention and curing of TB, including connecting their clients to housing, developing strong partnerships with health care providers, and implementing best practices in emergency shelters.

(One innovation discussed at the convening, though, was an ID card which would indicate that someone had been screened but could also act as an ID card for multiple services in the community.)

We must take TB seriously in order to eradicate it from shelters and other environments where people are at their most vulnerable. Education around TB is essential in our efforts to prevent its spread among those experiencing homelessness and the general public.