To ensure they don’t breathe TB germs, Shad Omwenyeke and other public health investigators wear hard-coated masks when they enter homes of tuberculosis patients. The investigators are fighting TB drug-resistance with directly observed therapy.

Photo and story by Dave Schafer

Shad Omwenyeke surreptitiously put a hard-coated breathing mask over his nose and mouth before stepping into the house.

Inside, a woman in her late 40s stood to greet him. Months ago, that would have been impossible. Tuberculosis had settled into her spine and paralyzed her.

But for six months, five days a week, Omwenyeke had been bringing her medicine to fight off the disease. They talked while she took her pills. He watched for side effects and cleaned the living room because she couldn’t.

Now, halfway through her therapy, she was improving, said Omwenyeke, a Health & Human Services senior public health investigator.

Omwenyeke wasn’t just helping a frail woman find health again. He was also helping the community.

Through directly observed therapy, he and other investigators ensure TB patients take their medicines and get better, preventing drug resistance and avoiding the outbreak officials for the Centers for Disease Control feared when a TB-infected man flew from Prague to Canada in May.

“Here in Houston, we have a good program, so we don’t have a lot of acquired resistance,” said Dr. Michel Abramsky, chief of the city’s Bureau of Tuberculosis Control. Keeping resistance down keeps the disease beatable.

“Tuberculosis isn’t real easy to catch,” Abramsky said. “It’s not casual exposure that gets you infected. It takes ongoing, prolonged exposure.”

Longer or shorter exposure increases or decreases the likelihood of contracting the disease.

TB comes in two forms: the innocuous TB infection and the active TB disease that can be fatal. Most of those who contract the infection likely won’t come down with the disease.

Nationwide, more than 14,000 cases of TB disease were reported in 2005. That was the lowest rate since national reporting began in 1953.
For those thousands, a complex regimen of drugs can fight off the disease.

The progression toward death
Latent TB is when someone contracts the mycobacterium tuberculosis bacteria, often after someone nearby coughs and ejects the germs into the air. A third of the world’s population, including 10 million Americans, is infected with latent TB, the CDC estimates.

Usually, the germs live in the lungs, but they can travel through the body and make a home in any part, including the kidneys, spine and brain, Abramsky said.

In most people who become infected, the body’s immune system fights the bacteria and stops them from growing. The latent TB germs stay inactive in the body, present no symptoms, don’t cause sickness and aren’t contagious. Unless a person takes a skin test, he probably won’t know he is infected.

Abramsky and the CDC only recommend people at risk, such as someone with HIV or uncontrolled diabetes, or people who work in jails, healthcare settings or homeless shelters, get screened for TB.
People with the infection can take the antibiotic isoniazid every day for six to nine months to kill the bacteria.

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