[Hpn] TB testing underway in homeless shelters

Graeme Bacque gbacque@colosseum.com
Tue, 09 Nov 2004 05:53:03 -0500


Nov. 9, 2004. 01:00 AM

TB testing underway in homeless shelters
Two workers being treated

Little risk to public, officials say


A massive hunt is underway for the homeless man who infected two Toronto 
Salvation Army shelter workers with a virulent strain of tuberculosis.

Toronto Public Health has begun saliva testing of 4,000 homeless men and 
shelter workers in an attempt to stem the transmission of the lung 
disease in the city's crowded shelter system.

Health officials said there is little risk to the public.

The health department decided to launch the testing campaign after it 
discovered late last month that a shelter worker at the Maxwell Meighen 
hostel at Sherbourne and Queen Sts. tested positive for the same strain 
of active TB contracted by a fellow worker who was tested in July.

Their tuberculosis type matches the strain that was responsible for an 
outbreak in the shelter system in 2001. Another four workers at the same 
shelter have tested positive for inactive TB, but are currently not sick.

"This is very frightening," said Cathy Crowe, a well-known Toronto 
street nurse. "Many of us, including myself, have contracted inactive 
TB, but this is the first case I know of where a shelter worker 
contracted active TB."

Crowe said that 10 per cent of people with inactive TB, which has no 
symptoms and is not infectious, will go on to develop the active strain 
in their later years.

"What if this active case of TB is out there, floating around? We don't 
know who it is. What if that person is using the Out of the Cold shelter 
program...? Many homeless people sleep in a different place every night. 
The risk is very, very alarming."

The hunt for the tuberculosis carrier raises the spectre of Toronto's 
homeless problem.

With cold weather moving in, more men and women who can't afford other 
options are expected to crowd into the city's shelters.

At a news conference yesterday, Toronto's Medical Officer of Health, Dr. 
David McKeown, said the department is taking a "very aggressive" 
approach to tracking down whoever is ill with the disease.

There are as many as 400 cases of TB reported in Toronto each year, most 
of which, McKeown said, were contracted before the carriers came to 
Canada and become active later in life.

Among Toronto's homeless, there are between 10 to 15 cases diagnosed 
each year.

McKeown said there is little risk to the general public. "Tuberculosis 
is transmitted usually through close or prolonged contact. It's not 
generally transmitted on the subway, in the workplace, in schools," he said.

Nevertheless, McKeown said, "I think the continuing transmission is a 
concern in itself. We shouldn't be satisfied that we have 10 to 15 cases 
amongst the homeless each year."

The two shelter workers, who were not identified, are feeling fine, 
McKeown said.

"They have begun treatment and are no longer infectious. Normally, when 
people have received several weeks of treatment and are not infectious 
and they are feeling fine, they can go back to work."

The treatment usually lasts for nine months and involves taking several 
different kinds of antibiotics each day, he said.

As for the other four workers who have been diagnosed with inactive TB, 
there is no way of knowing what strain they carry unless the disease 
becomes active within their system, he said.

The health department expects it will take at least three weeks to 
collect the saliva samples, which will be sent to a provincial 
laboratory for testing. A May inquest into the 2001 tuberculosis death 
of Joseph Teigesser, a homeless man, came out with 13 recommendations, 
among them that the province should provide funding for TB prevention, 
detection and treatment.

But the inquest's jury didn't deliver the recommendation  suggested by 
all parties with standing  that the provincial and federal governments 
fund an affordable housing plan to end homelessness, said Crowe.

"For me, it connects with the homeless winter plan. Are we going to open 
up more shelters and ones that won't be just a lot of mats crowding 
people on the floor?"

Major Ken Percy of the Salvation Army said the Maxwell Meighen hostel is 
already running full to capacity every night.

"During a cold snap, they are lining up at 6 a.m. to reserve a bed for 
the following evening," Percy said.

Percy said the Maxwell Meighen shelter has some private rooms and many 
smaller rooms.