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Stubborn but curable, tuberculosis persists in Snohomish County

Snohomish Health District fights TB with technology, meds & compassion

World TB Day— March 24

SNOHOMISH COUNTY— The number of new tuberculosis cases has inched downward in the past decade in Snohomish County, thanks to Snohomish Health District’s TB control team. Passionate about their work, the small band of nurses, outreach workers, office assistants and translators apply technology and thorough case management to detect, contain and cure TB.

In 1992, Snohomish County had 35 new cases of TB or 7.1 cases per 100,000 people. In 2001, there were 28 new cases for a rate of only 4.5 cases per 100,000 people. In 2000, there were 258 cases of active cases reported statewide, for a rate of 4.4 per 100,000 —the lowest TB incidence rate ever recorded in Washington state. That same year Washington ranked 24th in the nation for TB rates.

“In one way this is a success story because we see a measurable improvement in the incidence of the illness,” said public health nurse Maggie Osborn, RN, TB team leader, “but we’re not calling it a ‘victory’ until we push that figure down to zero.” For World TB Day, March 24, the TB team has sent information kits to selected health care providers and placed TB awareness posters in area libraries and hospitals throughout the county.

Last year the Health District gave more than 4600 skin tests to detect TB among patient contacts and as required for work, drug treatment programs and day care licensing. The 604 patients who tested positive for dormant TB infection received antibiotics to prevent development of active disease, and 28 active TB cases were found and treated.

The team works hard to ensure that patients with active TB take their medication regularly. Most often the TB staff travel to the individual’s home to observe the patient swallowing the prescribed pills. The program is testing observation via videophone, which has attracted the attention of the federal Centers for Disease Control and Prevention.

“One of our ‘candid camera’ patients is a seven-year-old who has a lot of fun with this,” said Osborn. “When his parents dial in to the clinic, he’s ready to go with his mouth wide open—we can practically see his tonsils.” Osborn said that the videophones’ virtual visit cuts down to three minutes an encounter that would take an hour of “windshield time” to visit the household in person.

“In our county, TB is not a disease of the poor or the homeless,” said Osborn. “ It is largely a disease of folks who have been born in countries where TB is still common and the TB bacteria just tags along. They often don’t know they are carrying it.” Osborn remarked that she and her team are enriched by their contact with non-English-speaking patients. “They come from amazing struggles with war, famine and persecution,” said Osborn. “They teach us daily lessons of humility, courage and love of family.”

More information about tuberculosis is available from If you feel you are at risk for TB [see sidebar], call your physician or schedule an appointment for a TB skin test appointment at Snohomish Health District’s clinics: 425.339.5220 in Everett, and 425.775.3522 in Lynnwood.

Established in 1959, the Snohomish Health District works to improve the health of individuals, families and communities through disease prevention, health promotion, and protection from environmental threats. Find more information about the Health District at



Who should be screened:

  • Populations with increased rates of TB infection. Examples include immigrants from high TB prevalence countries, injection drug users, migrant workers.
  • Persons with increased risk of progression to active TB if infected. Examples include people who have HIV infection, end-stage renal disease, or diabetes.
  • Persons with increased risk of recent exposure to TB. Examples include close contacts of TB cases and staff who work in health care or homeless shelters.

Frequently asked questions:

  • Q. I feel okay but I have a positive skin test for TB. Is that contagious to my family and friends?
    A. A chest X-ray is always done to see if the TB bacteria are causing damage to the lungs. If the X-ray shows no active TB disease, the person with a positive skin test is not infectious to others. We usually know in advance if someone may be infectious because those individuals are generally quite ill with coughing for three weeks or longer, weight loss, anorexia, fevers and excessive fatigue.
  • Q. What’s the difference between latent TB and active TB disease?
    A. People with latent or dormant TB infection have TB germs in their body, but the germs are not multiplying and causing damage. Such persons don’t feel sick and they are not contagious, but they have the potential to get sick if the TB germs become active and multiply. Persons with active TB have multiplying TB germs. They feel sick and have symptoms such as coughing, fever and weight loss. They can spread the disease to others if the TB germs are active in their lungs or throat.
  • Q. Do school children or food handlers need an annual TB test?
    A. No. Only those who are at high risk for TB exposure need the test.
  • Q. Can I catch TB germs from sharing drinking glasses, food or touching telephones?
    A. No. TB is spread when an infectious person coughs out bacteria in an enclosed airspace. Others in close contact on a frequent basis may breathe in the TB bacteria into their own lungs. It is not spread on papers, phones, pencils, linens or food.
  • Q. I got a shot for TB in school. That will keep me from getting sick with TB, right?
    A. Not if you got the “shot” in the U.S. Years ago, students in the United States got tested for possible TB infection routinely. The skin test for TB may have been misinterpreted as a vaccine. TB vaccine is given in some countries, but not in the U.S. These vaccines have only limited effectiveness.
  • Q. I had BCG (Bacillus Calmette Guerin) vaccine in my homeland. Should I get a TB test?
    A. Yes. People in developing nations may receive a vaccine called BCG. This vaccine may reduce serious TB complications and fatalities among infants and children in places where TB is common. The BCG vaccine does not prevent TB infection or disease. You should get tested for TB infection and, if infected, take the same medication as anyone who has not had BCG. In Snohomish County, 83% of our TB patients come from nations where BCG is given routinely, but they still got sick with TB. Scientists are hopeful for an effective TB vaccine in the next 10 years.
  • Q. My relative has TB. I have not seen him, but my husband visits their home often. Will my husband give me TB?
    A. In order to be exposed and infected with TB, you would have to be in the same home as the person who is now ill with TB in his lungs. Exposure does not happen indirectly. Bacteria are not carried home on clothing, papers or other objects.