As winter approaches, the homeless must worry about more than finding a vacant bunk in which to pass a cold night. Homeless shelters are breeding grounds for certain diseases, say state health officials, including tuberculosis, a respiratory disease that is contracted through close contact with an infected person.
TB screening in St. Louis shelters
The Missouri Department of Health and Senior Services has called on homeless shelters in the St. Louis area, which have reported 15 new cases of TB among its homeless, to begin screening residents for the disease.
In Columbia, screening for TB has not yet become a routine practice at the city’s homeless shelters. Mary Martin, public health manager with the Columbia/Boone County Health Department, said the last active case of TB reported by a local shelter was four years ago. No diagnoses of the disease have been made this year, Martin said.
TB test is time-sensitive
Martin said that while shelters in big cities tend to be residential, Columbia has more of a transient population, which is a problem for the time-sensitive TB test. Physicians screen for TB by injecting a test solution in the forearm. If there is a reaction at the injection site after 48 to 72 hours, the person might be infected with the disease, which is treatable with antibiotics if detected in time.
“The issue is people still being there after 48 to 72 hours to have their tests read,” Martin said. “We don’t go in regularly, partly because of turnover (in homeless shelters). We tend to screen only when there’s a definite concern.”
Officials at local shelters, including Salvation Army Harbor House, St. Francis House, Lois Bryant House and New Life Evangelistic Center, agreed that the transient nature of residents makes TB screenings difficult.
“People come and go every day. We just make sure we have our beds clean and that everybody showers daily,” said Keith Pryor, director of the New Life Evangelistic Center. “(Screenings) sound like something we should do, though.”
Columbia is low-risk community
Lucinda Thornhill, director of Harbor House, said lack of transportation to the health department could also stand in the way of shelter-mandated screenings.
“We usually say, ‘If you want to go get help, you can,’ and we encourage our workers to get tested,” Thornhill said.
For Lana Jacobs, a community member at St. Francis House, TB is “nothing new.” She contracted the disease as a child and said she knows the symptoms, which may include a prolonged cough, unexplained weight loss, night sweats, chills and fever. Screenings are a good idea for the homeless, Jacobs said, but are not something the St. Francis House will require.
Physicians at University Hospital see TB infections periodically, but most are from patients referred there from outside Columbia, said Infection Control Coordinator Eddie Hedrick.
“It’s a low-risk community here. Most (TB infections are) imported from someplace else,” Hedrick said. “For the majority of people that get infected, their bodies take care of killing the bacteria. For every 40 to 50 cases we see, only two or three develop TB.”