After more than a year of inactivity in a tuberculosis outbreak associated with an Aurora homeless shelter, the Kane County Health Department confirmed this week another active case was discovered in April, and a suspect case is under investigation.
From early 2010 until the fall of 2012, 46 active TB cases were reported as part of the outbreak, the first of which dated to 2007, health department spokesman Tom Schlueter said. The common link among all cases was exposure to Aurora's Hesed House.
Hesed House officials worked with the county to control the outbreak. A March 2012 report from the Centers for Disease Control and Prevention cited the county's handling of the situation as a model to follow. More than a year passed without the emergence of another active case.
Two months ago another patient was diagnosed with TB of the same genetic makeup as that of the outbreak cases, Schlueter said.
The Illinois Department of Public Health is testing another potential TB patient -- a procedure that could take six to nine weeks, said Barbara Jeffers, executive director of the Kane County Health Department. If the patient's genotype pattern matches the Aurora outbreak cases, the patient will be listed as another active case linked to the outbreak.
The case was reported to the health department after the patient checked into a hospital displaying signs of TB, Jeffers said. Further questioning led health officials to believe that the patient might have been in contact with somebody who had stayed at Hesed House, she said. But there is no way of knowing if the case is connected to the outbreak until the lab results are completed.
Until then, the patient is being treated in isolation, Jeffers said, adding that individual case information cannot be released.
"Suspect cases are just that, they're suspect," Schlueter said. "There have been other suspect cases that have never turned into full-blown active cases."
Jeffers said TB is difficult to control, especially in the homeless population. TB bacteria, which usually attack the lungs, are spread through the air. People can catch the potentially fatal disease from basic interaction with an infected person.
"That's why we need to know the genesis of it," Jeffers said. "We don't want it to continue to spread."
A person with active TB often has symptoms including a bad cough, chest pain, fever, fatigue and weight loss. The Atlanta-based CDC lists TB in the homeless population as a public health concern. It says homeless people often experience conditions that make them more susceptible to TB, such as substance abuse or congregation in homeless shelters.
And, Jeffers said, homeless individuals are harder to track down, which makes controlling an outbreak difficult.
At the height of the Aurora outbreak, Hesed House adopted precautionary protocols for TB control, Associate Director Neil McMenamin said. New guests must get tested for TB within 10 days of arrival. Doctors will refer guests to the county health department if any concerns arise.
The health department also sets up its own screenings at Hesed House each summer for every patient staying there, Jeffers said. Hesed House provides nightly service to up to 207 people, according to its website.
With these screening procedures, public health officials can track down people who have latent TB, meaning the disease is in the body but isn't contagious or active, Jeffers said. The patient can then get the infection treated before it converts to an active case.
Public health officials will monitor the patients with latent TB every day for about three months to make sure they are taking their medication.
"In the homeless population, if we see you have latent (TB), we start treating you right away," Jeffers said. "We don't know where you're going to be a year from now."
McMenamin said Hesed House staff members went through extensive training so they can recognize TB symptoms. Community health nurses are also "actively monitoring guests" at the Hesed House facility almost every weekday, he said.
In 2012, the homeless shelter's ventilation system was also replaced so air could circulate more frequently, McMenamin said.
The county, the CDC, the Illinois Department of Public Health, the city of Aurora and local hospitals have contributed to controlling the outbreak and implementing procedures for prevention at the homeless shelter, McMenamin said.
"All of these departments put (TB) on their radar ... to kind of tackle this issue," he said.