No Secrets: DOH Forthright in the Protection of Floridians from TB

Dear Fellow Floridians:

As your State Surgeon General, it's important that people have the facts on the isolated cluster of tuberculosis (TB) in Duval County. I assure you that the Florida Department of Health (DOH) has been and remains wholly committed to preserving Floridians' health, including the protection from diseases such as TB. Unfortunately due to misleading reporting from the Palm Beach Post this week, facts have been distorted. The people of Florida weren't provided accurate medical details on TB to properly understand their risk and as medical experts, we are the authority in this matter. It is nearly impossible to catch TB simply by passing an infected person on the street. To be at risk, you must be exposed to the organisms constantly, by living or working in close quarters with someone who has the active disease. Even then, because the bacteria generally stay dormant after they invade the body; less than 10 % of people infected with TB will ever come down with the active disease. The remaining 90% will show no symptoms of the disease, nor will they be able to spread the disease to others.

I am disappointed that after a personal and in-depth discussion with the Ms. Singer about several Department topics, including the July 2nd end of patient care at A.G. Holley, the Palm Beach Post made a reckless choice to misinform you by reporting on a cluster of TB patients that posed no public health risk and positioning this as a secret. Not only was the cluster of TB patients in Duval County not kept secret, but rather DOH and the Duval County Health Department publically addressed it, working openly with the Centers for Disease Control (CDC), local leaders and community partners via the Jacksonville Community TB Coalition.

The article failed to capture the Department's important work with the local homeless shelters to identify clients who need to be evaluated due to exposure. Her article did not mention the critical role DOH has played in moving the state forward to continue treatment of the most extreme TB patients after the A.G. Holley closure via partnerships Jackson Health System and Shands Jacksonville. The article implies that this TB cluster "spread beyond the cities underclass" when, in fact, the CDC report itself sites no evidence that this strain of TB has spread to the general population.

DOH has been and remains fully engaged in treating and caring for the affected Floridians. We are continuing to fulfill the CDCs recommendations for this Duval County cluster and, as the state's public health agency, remain constant in our commitment to providing open and transparent protection for the health and safety of you, your family, and all Floridians.

CDC Recommendations for Duval County Cluster include:

Active case finding at sites A and G every 8-10 weeks until no new cases are found
Periodic TB screening at all sites, including sites A and G, after active case finding is complete
Evaluate and prioritize contacts for LTBI treatment according to risk of progression to TB disease after TB infection exposure to an infectious case
Implement a formal TB infection control program with standard operating procedures at all sites, building upon existing efforts from Duval County Health Department
Continue to improve management of all cases and contacts at Duval County Health Department

Inaccuracies from the Palm Beach Post Article on Tuberculosis in Duval County
1. "Linked to 13 deaths and 99 illnesses,"
- Does not specify time span of deaths and illnesses. Most deaths are from other causes (i.e. HIV, Hepatitis C) with TB being present in addition.

2. "Dr. Robert Luo's 25-page report describing Jacksonville's outbreak and the measures needed to contain it went unseen by key decision makers around the state."

- Report was a result of CDC's site visit that included collaboration with DOH, Duval CHD and local stakeholders. DOH and Duval CHD have implemented the recommendations from this report. Short-term recommendations have been met and the coalition is now working towards long-term recommendations.

3. "Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville's homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida's outbreak was, and is, far from contained."

– DOH and Duval CHD has concentrated outreach efforts, including testing and treatment (if necessary), to those who may have been considered at-risk. Not all identified contacts meet the at-risk criteria.

4. "The public was not to learn anything until early June, even though the same strain was appearing in other parts of the state, including Miami."

- The public has been engaged in this cluster investigation from the very beginning and the public has been involved in the education process throughout the investigation. Community stakeholders and partners have been engaged through the Jacksonville Community TB Coalition.

5. "Last week, with A.G. Holley now closed, one was sent to Jackson Memorial Hospital in Miami. The ones who will stay put in Jacksonville are being put up in motels, to make it easier for public health nurses to find them, Duval County health officials said."

– Duval CHD does not transition patients eligible for hospitalization to motels for the administration of DOT TB treatment. Only patients considered not to be contagious are housed under those conditions.

For media inquiries, please contact the Florida Department of Health's Office of Communications at (850) 245-4111.