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Lynn clinic works to bring tuberculosis out of hiding

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LYNN — Antonio Frias took it in stride when he heard the blood test results: He was infected with tuberculosis.

“I wasn’t upset, because God knows what he has in store for me,” Frias, a 76-year-old retiree, said through a translator on a recent visit to the Lynn Community Health Center. “But I have to follow up. I have to do my part.”

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And so he does, taking a pill every day, as prescribed, even though his infection is inactive and doesn’t make him feel sick.

Frias has a TB infection that he may have carried, without knowing it, since before he left the Dominican Republic 30 years ago. His case was detected because the health center is taking a rare, aggressive approach to tuberculosis by identifying and treating infected people before they become sick.

And a recent $1.5 million federal grant to the Massachusetts Department of Public Health — the only one awarded in the country — will vastly expand that effort.

Tuberculosis, one of humankind’s oldest foes, has been killing people for tens of thousands of years and today infects one-third of the world’s population. It can attack any part of the body, but most often starts in the lungs, leading to bloody coughs, weakness, fever, and night sweats. But tuberculosis is little seen and little understood in the United States, where it is often misdiagnosed as pneumonia.

While only about 9,500 tuberculosis cases are diagnosed nationwide each year, as many as 13 million people could, like Frias, have “latent” TB, said Dr. Philip LoBue, director of the Division of Tuberculosis Elimination at the US Centers for Disease Control and Prevention. The CDC awarded the grant to Massachusetts to find ways to capture many more latent cases. “There’s pretty much no way we’re going to eliminate tuberculosis unless we do that,” LoBue said.

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One in 10 people with latent TB eventually develop active disease, which makes them very ill and capable of spreading the illness to others. These people are the source of most new cases of active disease in the United States, LoBue said.

Treating active TB is an expensive ordeal, costing $17,000 per person, on average. Depending on how sick they are, patients often need to be hospitalized or isolated. They must take as many as nine pills a day for nine months or longer, and a public health nurse visits every day to make sure they do so. Failure to take all the medication until the infection is stamped out can lead to strains of tuberculosis that are resistant to medications, a big problem overseas.

In contrast, latent TB can be treated with one or two drugs taken for four months, at an average cost of $500 per person.

Public health departments typically have the resources to manage only active tuberculosis cases. A few cases of latent TB might be identified when nurses trace the contacts of people who became ill. But the Lynn Community Health Center, working with the state Department of Public Health, has been a step ahead, with a focus on finding latent TB.

The main medical provider for a city of immigrants, the health center serves as a processing center for the federal refugee resettlement program. It tests all these newcomers for tuberculosis, and previously sent both latent and active cases to the state’s TB clinic in Salem. But it was difficult for patients to travel to Salem, and many did not complete their treatment, said Dr. Hanna H. Haptu, director of the center’s TB clinic.

So in 2013, the health center started managing the latent cases on its own, eventually expanding the effort to include all its patients with latent TB, not just refugees.

The CDC grant will take it to the next level over three years. In the first year, the health center will focus on stepping up screening within the center, giving blood tests to all people considered at risk of TB: immigrants from countries where it is endemic, homeless people, people with HIV, inmates, and people taking drugs that suppress the immune system.

Then, the plan calls for drawing in patients from throughout the community. The grant pays for a project manager and two outreach workers who will work with churches, shelters, and community groups to screen 2,500 people a year, with the goal of curing 80 percent of those found to be infected.

One-third of Lynn’s population is foreign-born, with most coming from countries where tuberculosis is endemic. Across the country, about two-thirds of tuberculosis cases occur in people born overseas.

Still, it was an American-born doctor whose illness helped the city get ready. In 2015, a Lynn Community Health Center physician, Dr. Kelly John Holland, developed an active case of TB.

“That triggered hysteria in the community,” Haptu said, because the doctor had come in contact with so many people. The health center ended up screening more than 1,000 contacts.

While traumatic, the Holland case was also an opportunity to educate the community about the difference between latent and active TB. “That kind of helped our mission,” Haptu said.

Melis Celmen, project manager for the CDC grant, said one challenge will be overcoming the stigma tuberculosis has among immigrants.

“When patients hear TB, they get scared,” Celmen said. “The patients start crying, ‘Oh, did I do anything bad?’ ”

Deborah A. McManus, the TB clinic’s nurse manager, said: “We have to ensure they understand that all they did was breathe.”

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.



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