Outbreak of 17 Cases of Multi-Drug-Resistant TB Reported in Minnesota

An outbreak of 17 cases of multi-drug-resistant (MDR) tuberculosis (TB) has been reported in Ramsey County, the second most populous county in the Minneapolis-St. Paul metropolitan area, a spokesperson for the Minnesota Department of Health confirmed to Breitbart News on Monday.

“The outbreak has primarily affected elderly residents in the Hmong community, with 10 cases linked to a senior center where the first case was detected in 2016. Four other Hmong residents were also infected. So far six of the 17 people have died, three as a direct result of tuberculosis [TB],” the Star Tribune reported on Monday adding:

Some of the first transmissions occurred among a group of seniors who regularly played cards at the senior center.

But one of the card players had been sick and infectious for five years before diagnosis. That has left public health officials playing catch up in an effort to find everyone who is at risk.

“It’s important to remember that most of these are men or the close relatives of men who fought for us in Laos during the Viet Nam War,” the Minnesota Department of Health spokesperson told Breitbart News.

Nine additional cases of MDR TB have been reported in Ramsey County since April, when health officials had identified only eight total cases, the Star Tribune reported at the time.

MDR TB is a dangerous and expensive to treat form of active TB.

“Active TB can usually be treated successfully in six to nine months at a cost of $17,000 per patient, according to the Centers for Disease Control (CDC), but MDR TB treatment costs more than $150,000 per patient and can take between 20 and 26 months,” as Breitbart News reported:

The six to nine month treatment regimen for active TB, which has been standard practice in the United States for some 50 years, involves a combination of four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

Over the past several decades, new strains of TB have developed around the world which are resistant to at least two of these four drugs, hence the term MDR TB. Treatment for MDR TB begins only after the patient is observed to be resistant to the standard four drug protocol. Subsequent to diagnosis, a number of expensive “second level” drugs are added to the patient’s treatment regimen.

The treatment of active TB has become so effective that virtually all patients who are diagnosed with the disease in the United States survive, provided they are diagnosed early and follow their treatment regimen.

In contrast, the morbidity rate among those diagnosed with MDR TB worldwide is 39 percent, as Breitbart News reported:

Worldwide, the number of MDR TB cases has increased from 273,000 new cases in 2000 to 480,000 new cases in 2014. During that same time, the number of new active TB cases worldwide each year has fluctuated around 9 million.

In 2014, an estimated 1.5 million people (17 percent of the new TB cases that year) died of TB. Of those, 190,000 died of MDR TB (39 percent of the new MDR TB cases that year). In the United States, 550 people died of the 9,421 new cases that year (one half of 1 percent). (Note: the overall number of active TB cases increased by 1.7 percent in 2015 to 9,563). . .

The higher worldwide morbidity rate of TB, compared to the United States, is largely due to the fact that almost every new patient in our country goes through the six to nine month regimen with the standard treatment of those four usually reliable drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

MDR TB has been a public health problem in the rest of the world for decades. Though it is still relatively rare in the United States, it appears to be on the increase.

As Breitbart News has reported extensively over the past several years, the percentage of those diagnosed with tuberculosis in the United States who are foreign-born has more than tripled over the past three decades, from 22 percent in 1986 to over 67 percent in 2016.

Foreign-born cases of TB are a particular problem in refugee-friendly Minnesota.

Ninety percent of the 168 cases of active tuberculosis diagnosed in Minnesota in 2016 were foreign-born.

That represented an increase from the 81 percent rate of foreign-born cases among the cases of active tuberculosis diagnosed in Minnesota between 2010 and 2014 (593 out of 732). “Of [these] foreign-born cases, 50 percent, or 296, were refugees, according to ‘The Epidemiology of Tuberculosis in Minnesota, 2010-2014,’ a report published by the Minnesota Department of Health,” Breitbart News reported.

“We know we are already seeing more cases than we would have anticipated, and we far outnumber cases in other parts of the country,” Anne Barry, director of the St. Paul-Ramsey Public Health Department, told the Star Tribune.

Several of those diagnosed with MDR TB in the current Ramsey County outbreak were housed in refugee camps prior to their arrival in the United States, the Star Tribune reported:

At least four of the 10 Hmong elders who were infected in the senior center had spent time at a camp in Thailand that housed many Hmong refugees and is known to have high tuberculosis infection rates.

Many affected Hmong elders don’t understand why they need to be treated again for tuberculosis after many were given medication when they arrived here.

“It is not just translating for language, it is translating for culture,” said Barry, whose department has long employed workers who grew up in the Hmong community. “An emergency is not the best time to build a relationship.”