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Six have died from multi-drug-resistant tuberculosis in Twin Cities, officials say

ST. PAUL—In the past two years, Ramsey County has had 17 cases of multi-drug resistant tuberculosis, a drastic increase from the one-or-fewer average in other years.

Six of the 17 have died, with three of those deaths being directly attributed to tuberculosis, said Kris Ehresmann, director for Infectious Disease at the Minnesota Department of Health, on Monday.

Of the 17 cases, 14 were in the Hmong community and 10 are associated with individuals who participate in activities at a senior center, Ehresmann said.

Though it's the largest outbreak in the country, Ehresmann said it does not pose a concern to the general public.

"It's important for folks in the Hmong community to know that if you have older family members who have symptoms, cough, weight loss, night sweat, and other symptoms that are compatible with TB, you should be aware that this is something to be considered," Ehresmann said. "But definitely the general public need to know it's not a concern. I would hate for anybody to think 'I'm not going to talk to my Hmong colleague or my Hmong friend' because of this."

Tuberculosis is not easily transmitted and requires close, prolonged contact with an infected person to be transmitted, Director of St. Paul-Ramsey County Public Health Anne Barry said Monday.

Treatments for multi-drug resistant tuberculosis are much harsher than regular (pansensitive) tuberculosis treatments. Because the organism has developed resistance to at least two drugs, multi-drug resistant tuberculosis treatments cost on average $134,000 and take up to two years. All 17 of the Ramsey County individuals had to be hospitalized for a time, Ehresmann said.

In contrast, pansensitive treatments cost an average $17,000 and require six to nine months of treatment. The number of pansensitive tuberculosis cases has not changed recently.

Most of the cases have been in Ramsey County, but other east-metro counties have seen the disease as well, Ehresmann said.

The department estimated the cause of the outbreak dates back to Vietnam War. After helping the United States in the war, Hmong refugees fled first to Thailand and then gradually to the United States. Many of them came from the WatThamKrabok camp, Ehresmann said, which exposed many of its refugees to both multi-drug resistant and pan service tuberculosis.

More than 3,000 refugees ultimately resettled in Minnesota, bringing possible exposure with them.

Authorities don't know how many of these latent tuberculosis infections are multi-drug resistant and how many are pan service, Ehresmann said, and there's no way to test it. About 10 percent of latent tuberculosis infections reactivate when the carrier gets older and more vulnerable.

Minnesota officials are now discussing it because of the Ramsey County outbreak, but multi-drug resistant tuberculosis is an issue worldwide, Ehresmann said. About 25 percent of the population worldwide is estimated to have latent tuberculosis.

The state has identified more than 500 people to monitor for possible exposure, most of whom also participate in senior activities. The Department of Health is working with the Hmong community to raise awareness, Ehresmann said.

The Department of Health also requested $224,635 from the state's new public health response fund to limit the disease's spread.

Ramsey County health officials are heading the Health Department's efforts, working directly with clients, Barry said.

"In our partnership with the Minnesota Department of Health, we're really the front line," Barry said. "We're working directly with the community and with people of the community in the health department, so we have health educations, community health workers, nurses who are in and of the Hmong community, and that's an essential part of the work that's being done here. We're often not trusted by people of the community, so having relationships has been essential."

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