One in five homeless people with tuberculosis die within a year of their diagnosis, according to a study led by St. Michael's Hospital's Dr. Kamran Khan. And that number remains unchanged over the last decade despite recommendations calling for greater improvements in prevention and control of tuberculosis in homeless shelters.
A provincial coroner's inquest into the death of Joseph Teigesser, a homeless man who died of tuberculosis in Toronto in 2001, made 13 formal recommendations. These included provincial funding for a centralized clinic system to provide specialized care for those with tuberculosis in Ontario and a review and improvement of shelter ventilation systems. However, the work surrounding these two key recommendations has fallen short, the researchers say in the study.
"The treatment of tuberculosis is often complicated by inadequate housing, substance dependence, language barriers, mental health problems, not to mention the enormous stigma that comes with this disease," Khan says. "To effectively control tuberculosis, centres with specialized expertise and resources are needed to address these complex issues."
The 10-year study, published in the March issue of the journal Emerging Infectious Diseases, also found a growing proportion of tuberculosis cases in Toronto's homeless shelters are in immigrants, raising the risk that dangerous drug resistant strains of tuberculosis could enter the shelter system.
The study found nearly 40 per cent of all tuberculosis cases in the homeless were in immigrants. About 56 per cent of all infections in immigrants involved strains that were not known to be circulating in the city, and were likely acquired in other parts of the world where drug resistance is common.
Historically, tuberculosis in Toronto's homeless population was mostly a disease of Canadian-born men. While highly drug resistant tuberculosis is unusual among people born in Canada, it is an emerging threat in many developing areas of the world. If a drug resistant strain of tuberculosis were introduced into the shelter system, it could set off an outbreak that would have serious public health implications and be very difficult to control. Financial resources to manage such an outbreak would dwarf the costs of strengthening preventive measures today, the researchers warn.
"There's been a lot of good work on tuberculosis prevention and treatment in the homeless sector in Toronto over the last several years, and ventilation systems in shelters have improved, although dedicated funds are needed to make further improvements," said Dr. Elizabeth Rea, a study co-author and associate medical officer of health with Toronto Public Health. "But we also need more affordable housing and we need better access to primary and specialized care for vulnerable homeless individuals."
Tuberculosis is a serious, contagious disease caused by a bacterial infection. Once a person is exposed to tuberculosis, the infection can remain dormant for years to decades before becoming active. However, persons with weakened immune systems, including many homeless persons, are at much greater risk of developing the active form of tuberculosis. While most tuberculosis cases are treatable, highly drug resistant strains of tuberculosis can be life threatening and require years of treatment to cure.
"We need to do a much better job in preventing tuberculosis from spreading in this vulnerable population, and in providing timely, effective clinical care for those who are affected by this disease," says Dr. Michael Gardam, co-author and director of the tuberculosis clinic at the Toronto Western Hospital. "We have shown in previous research that treatment in dedicated tuberculosis clinics by experienced staff plays a major role in improving the likelihood of survival from tuberculosis."
About St. Michael's Hospital
St. Michael's Hospital provides compassionate care to all who walk through its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael's Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.
Julie Saccone | EurekAlert!
WAKE-UP provides new treatment option for stroke patients | International study led by UKE
17.05.2018 | Universitätsklinikum Hamburg-Eppendorf
First form of therapy for childhood dementia CLN2 developed
25.04.2018 | Universitätsklinikum Hamburg-Eppendorf
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
22.05.2018 | Life Sciences
22.05.2018 | Earth Sciences
22.05.2018 | Trade Fair News