BROCKTON — Dr. Shrein Saini tested 200 immigrants for tuberculosis over the last year. Eight out of 10 had the latent — that’s to say, not contagious — version of the disease.
Saini wants to get the word out that latent TB is both easily treatable and nothing to be ashamed about. “It’s not something that they did wrong. It’s just the fact that they came from a country where it’s endemic, just like Lyme disease here,” said the Tufts-trained physician. She heads the TB clinic at Brockton Neighborhood Health Center.
Brockton averages about six cases per year of active TB, according to state statistics for 2017 to 2022. Dormant TB can flare up into active, transmissible TB at any time, often brought on by stress or a weakened immune system. That’s why Saini wants newcomers to get tested.
“If we can make sure that latent tuberculosis patients are under treatment,” Saini said, “I think we can prevent those active cases.”
Her preferred method is a blood test. There’s also a skin test. If either one is positive, she takes an X-ray of the person’s chest. Most tuberculosis attacks the lungs, though it can target the spine, skin, uterus or brain. After a positive result, the clinic provides treatment that may take three to six months. Generally the patient takes two pills every day and comes in once a month for blood work, Saini said. The treatment is free to the patient via Brockton Neighborhood Health Center. It drops a person’s lifetime chance of getting active TB from 5% to less than 1%.
If you’re reading this and think it doesn’t apply to you because you’ve been vaccinated in your home country before moving to Brockton, think again. That vaccine’s effectiveness swings from zero to 70%, Saini said.
What is tuberculosis?
Tuberculosis comes from a kind of bacteria that spreads through the air when infected people cough, sneeze or spit, according to the World Health Organization. You must be in close contact with someone with untreated tuberculosis disease of the lungs for a long period of time and need to breathe in TB germs for infection to occur, Saini said.
For people born in the United States, tuberculosis may sound strange or frightening. But that’s largely because it is no longer established here. As recently as 1992, the U.S. had an infection rate above 10 per 100,000 residents. Getting countries at or below that that rate has been a major public health goal.
Globally, one person in four is infected. About 10 million people get active TB per year, according to the World Health Organization’s most recent tuberculosis report. It killed about 1.3 million people in 2022. Worldwide rates of the disease have been falling the last two decades amid sustained public health campaigns to combat it. However, rates saw a small uptick during COVID.
Saini became a TB specialist in part because it remains rampant in her native India. “India is the tuberculosis capital of the world,” said Saini, who is from the Punjab region.
Dr. Carlos Acuña-Villaorduña of Boston University, who helped train Saini at Jamaica Plain’s Shattuck Hospital, said the long latency period poses a challenge. “The tricky part is that people don’t tend to get sick immediately,” he said. “Nowadays it’s very easy to immigrate from one country to another.”
‘Not a concern for residents’
Brockton Executive Health Officer Eno Mondesir serves on the state’s Medical Advisory Committee for the Elimination of Tuberculosis. He worked in a tuberculosis lab for three years. He said Brocktonians do not need to worry about TB. “Latent tuberculosis should not be a concern for residents,” Mondesir said.
The closure of Signature Healthcare Brockton Hospital and the uncertainty around Good Samaritan Medical Center’s future means patients might have to seek treatment in Boston. It’s an inconvenience for the handful of Brockton patients who come down with active TB each year, he said.
Patients with active TB get quarantined for two weeks in “negative pressure” rooms that keep the airborne bacteria isolated. Brockton Neighborhood Health Center lacks such a room, Saini said. Such cases would be treated at Good Sam, which has the setup needed. After that 14-day quarantine, Mondesir said, patients cannot infect other people.
Brockton tends to have about double the state average of active TB cases. Five cities, including Quincy, have higher rates.
How do I get tested for TB?
Call Brockton Neighborhood Health Center at 508-894-3379.
Send your news tips to reporter Chris Helms by email at CHelms@enterprisenews.com or connect on X at @HelmsNews.
