The outbreak is the first in the state since 1989.

PORTLAND (AP) – Public health workers are continuing to search for people who had close, extended contact with six homeless men in Portland who were diagnosed with tuberculosis in Maine’s first outbreak of the disease since 1989.

The outbreak was first detected in August 2002. Because of the mobility of the homeless population, the search is now spreading beyond city limits.

So far, about 120 of 300 people on a “high-priority” list have been found and preliminary test results show that 28 have latent tuberculosis, meaning they carry the bacteria but are not infectious like the active cases.

The city is trying to find others on the list by querying shelters, jails and treatment centers around Maine where members of the high-risk pool may have been. Public health workers are also contacting advocates for the homeless, said Nate Nickerson, the public health director for the city’s Department of Health and Human Services.

Public health officials said it is important to test as many high-risk people as possible, and put infected individuals on a strict, months-long antibiotics schedule that can successfully cure TB and prevent its spread.

To develop a more comprehensive approach toward tuberculosis, the state hopes by year’s end to set up an information network that includes homeless shelters, methadone centers and county jails around Maine – all places that could be frequented by the homeless population, said state epidemiologist Dr. Kathleen Gensheimer.

“We need to break this cycle of tuberculosis transmission . . . we need to put control measures in place,” Gensheimer said.

Maine’s last TB outbreak, in 1989, affected more than 700 people connected to Bath Iron Works, Gensheimer said, and 24 cases developed into active disease, Gensheimer said.

Cases could be traced back to one employee, who was coughing, experiencing night sweats and losing weight for about nine months before he was diagnosed with tuberculosis.

Three of the six Portland cases can be linked to one man who made 42 trips to the emergency room and received several chest x-rays before he was diagnosed with the disease this past March.

Dr. Stephen Sears, infectious disease specialist at Maine General Medical Center in Augusta, urged health care workers attending a conference Thursday at the Augusta Civic Center to be vigilant of patients with symptoms.

“You have to raise your suspicions higher or you’re going to miss it or not think of it when someone comes in,” Sears said. “A lot of people are sick, but they don’t actually look sick.”

So far this year, the state is posting its typical number of tuberculosis cases – about two dozen. Aside from the Portland outbreak, all of the cases are isolated, Gensheimer said.

AP-ES-11-06-03 0217EST

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