Public Health has noted a recent uptick in cases of TB that are part of a genomically-linked cluster among people who are under-housed.
Case demographics show:
- almost 80% are male;
- two-thirds ≥40 years age;
- almost 60% from Surrey; and,
- three-quarters are Canadian-born.
Among this cluster, the 4 most common risk factors identified are:
- homelessness, in >60%; tobacco use; other substance use; and, group living.
Fortunately, drug resistant TB has not been associated with this cluster but of concern, two-thirds of newly identified cases are smear-positive, suggesting delay in diagnosis. Over half of the cases reported TB-compatible symptoms.
Due to the transient nature of groups who may be impacted, the key to stopping transmission is having a high clinical index of suspicion for TB so that cases are diagnosed and identified promptly.
Please consider TB - particularly in patients with risk factors that have been associated with this cluster, or TB disease more generally (e.g., immunosuppression) especially if patients present with:
- fever
- persistent cough, hemoptysis
- fatigue, anorexia, weight loss, night sweats
If suspicious, please recommend and support the patient to get a CXR and arrange for collection of 3 sputum samples for testing. Note that tuberculin skin testing is not appropriate if active TB disease is suspected.
Shigella flexneri:
An outbreak of Shigella flexneri has been identified in residents of Vancouver’s Downtown Eastside, with multiple patients requiring hospitalization. Fraser Health is also seeing an increase in Shigellosis in the homeless/transient population, as many these clients may frequent the Downtown Eastside.
Cases may present with diarrhea, fever, nausea, cramps and tenesmus. Shigella can cause diarrhea that is bloody, mucoid, or watery. Transmission is via the oral fecal route and can spread via food, any object touched by dirty hands, or sexual contact. The infectious dose is only 10-100 organisms so vigilant hand hygiene is necessary to prevent transmission.
Please consider Shigellosis in the differential diagnosis of Fraser Health patients presenting with gastroenteritis if they are homeless, under-housed, or part of the social network of the Downtown Eastside:
- Send stool culture for bacterial enteropathogens (Stool C+S).
- Consider treating patients empirically to reduce secondary transmission if your patient is unable to meaningfully isolate from others and maintain proper hygiene until their symptoms resolve.
- If treating empirically, please use Azithromycin 500mg PO x 3 days. For patients with a contraindication to Azithromycin, Cefixime 400mg PO daily for 5 days can be used. Recent cases have been resistant to Ampicillin, TMP/SMX, and Ciprofloxacin
The Fraser Health Medical Health Officers (MHO) are available for medical consultations and can be reached at 604-587-3828 or 1-877-342-6467.
To page the MHO on-call after hours: 604-527-4806.