WASHINGTON, USA — The Tacoma-Pierce County Health Department issued an advisory Wednesday to healthcare providers to test for tuberculosis (TB) in people who were incarcerated. This is after a large outbreak in the prison system in 2021, which may still be having an impact.
Since July 2021, the Washington State Department of Health (DOH) and Department of Corrections (DOC) identified 28 people with active TB and 2,900 potentially exposed contacts. However, over 800 people left prisons before officials identified their exposure to TB, and many have not been notified or tested.
TB is spread through the air when an infected person coughs or sneezes. However, it is less likely to spread than the cold or flu. In order to be infected with tuberculosis, a person typically must be exposed to it more than once and for a prolonged amount of time within a confined space.
Those at increased risk of infections are those who travel to areas where TB is more prevalent and those who work in places like homeless shelters and nursing homes where TB exposure is more likely.
Correctional facilities also have seen a particular increase in TB cases likely because these settings involve individuals who are exposed to others for a prolonged time.
According to the Centers for Disease Control and Prevention (CDC), from 2014 to 2020, there were no TB cases reported at Washington state prisons. 2021 marked the first recorded TB outbreak in WADOC and the largest in Washington state in 20 years.
Health officials attribute the outbreak to the suspension of annual testing for TB, in some cases for up to two years when the DOC moved resources to COVID-19 measures instead. In addition, a five-year pause in TB cases and the fact that symptoms for TB overlapped with COVID-19 led to delayed detection.
The Washington Department of Health said not everyone who is exposed to TB becomes infected with TB and not everyone who becomes infected goes on to develop disease. The department said 5 to 10% of otherwise healthy people infected with TB will develop TB disease and a person is not infectious until they develop TB disease.
A class action lawsuit was also filed in September against the Department of Corrections alleging they mishandled the tuberculosis outbreak. The lawsuit states:
"This case involves the largest tuberculosis outbreak in Washington in over 20 years and one of the largest outbreaks in the Country in a correctional institution. The outbreak occurred due to the Defendant’s failure to properly screen inmates for tuberculosis, delay in diagnosing inmates with a known history of tuberculosis, failure to require inmates and guards to wear proper protective equipment (“PPE”), and the failure to institute measures to quarantine inmates once it was known that tuberculosis was spreading throughout the prison. This outbreak has infected more than 269 inmates."
The Department of Corrections did not comment directly on the lawsuit, but did say the following:
"It was unfortunate what happened at the time, and we learned a lot from that," said Chris Wright, the spokesperson for the Department of Corrections, "We did the extensive investigation with the federal and state authorities and since then, fortunately, have not had an outbreak again."
He also added, "It was an extensive process during the outbreak and we did screen and test thousands of individuals. And of course, unfortunately, 25 people still had it. It's a terrible disease."
In 2021, 199 cases of TB were reported in Washington, a 22% increase from the previous year. Most of these cases were reported in the Puget Sound region, with King, Pierce and Snohomish counties being the hardest hit.
According to the Department of Health, tuberculosis disproportionately affects vulnerable populations in Washington state. On average, five cases are diagnosed each week. After a decade of generally decreasing diagnosis rates, incident rates rose "similar to the trend seen in the United States as a whole," according to the department. In 2022, 251 cases were reported.
In September 2023, 135 people were also recommended to be evaluated for tuberculosis after a Kentridge High School community member was diagnosed with active tuberculosis, according to Public Health – Seattle & King County.