Disease sleuths try to stop spread of infection

Every day, public health workers throughout Colorado knock on doors or make calls to track down people who may have been exposed to a reportable, contagious disease.

It could be whooping cough or HIV, mumps or meningitis. Doctors and laboratories are required by law to report certain diseases to state and local health departments, which then begin investigations aimed at stopping the spread of infection.

The state’s chief medical officer calls such work “shoe leather epidemiology.”

“We track people down as quickly as we can,” said the official, Dr. Ned Calonge. “Public health will go to people’s houses.”

Although diseases are tracked and statistics regularly posted on the state Health Department Web site, workers’ efforts usually get little notice.

But some cases make headlines, such as the recent tuberculosis death of a 19-year-old college student from Nepal. Kalpana Dangol, who attended Colorado State University at Pueblo and lived in Colorado Springs, died at Memorial Hospital on June 8.

Although public health officials investigate and treat about 120 TB cases across the state each year, the fact that the victim died — no local deaths specifically from TB had occurred in the past five years — elevated its profile.

(Dangol’s was officially the second TB-related death in El Paso County this year. In March, an autopsy revealed a man who died in a car crash had active tuberculosis. Although he died of crash injuries, his death was recorded as TB-related.)

Had it not been for publicity surrounding Andrew Speaker, the Atlanta lawyer undergoing treatment for an especially dangerous strain of tuberculosis at National Jewish Medical and Research Center in Denver, the Springs case likely wouldn’t have garnered as much interest, Calonge said.

Last week, health departments in El Paso and Pueblo held TB skin-testing clinics for people who may have been exposed in the Dangol case. About 160 people were identified for testing, including 15 employees at Memorial Hospital.

In a separate TB investigation in October, health officials tested 222 people after a teacher in Falcon School District 49 with an extensive travel history was found to have the disease.

Other recent communicable disease investigations, although much larger, have been much quieter.

In May, a case of whooping cough in a child led to a twocounty investigation.

“Basically, this investigation got huge,” said Dr. Bernadette Albanese, medical director at the El Paso County Department of Health and Environment.

An estimated 1,000 people in Teller and El Paso counties were notified they may have been exposed to the bacterial disease, formally known as pertussis. Six cases were confirmed. Last week, lab results confirmed two more unrelated cases that sparked tracking.

The El Paso County Health Department also helped tackle a measles investigation that originated at the Intel International Science and Engineering Fair last month in Albuquerque. Sixteen people from El Paso County at the fair needed to be notified after New Mexico officials announced that a 15-year-old girl from India who attended the event had the disease. None of those potentially exposed became sick, Albanese said.

Seeking people out in such cases often falls to Corliss Brecht, a communicable disease specialist who works in the basement of the Health Department.

“Usually, this is a phone conversation,” she said. “I’ll introduce myself as being a public health nurse from the Health Department and let them know I was investigating a case of whatever the disease is, and I understood they may have been exposed.”

Brecht explains the disease and how it spreads, and then she helps arrange testing.

Overwhelmingly, people cooperate when asked to submit to testing for communicable diseases, said Rosemary Bakes-Martin, administrator of the El Paso County Department of Health and Environment.

For those who refuse, there can be consequences.

“If we really felt like there was somebody who was going to infect others, we would have some powers we could take advantage of,” Bakes-Martin said.

It’s a power she has used.

About a year ago, the department issued a “cease and desist” order to someone with HIV who continued having sex and in another instance, ordered that a person with active TB be quarantined to his home.

A TB quarantine case in Arizona continues to make national news. Robert Daniels, originally from Russia, has spent the past nine months in a medical jail ward because he is viewed as a dangerous health threat. He was confined for failing to wear a mask in public.

By law, public health officials must keep health information confidential, although such high-profile cases often make their way to the media, sometimes when the patients decide to step forward.

In the Dangol case, her identify was released by the Coroner’s Office, not health officials, who said privacy laws restrict them from releasing names, regardless of whether the person has died. Records from the Coroner’s Office, however, are public.

“Certainly, the media was very upset with me for refusing to give this person’s name,” Calonge said. “If I thought that we needed to release the name in order to protect the public, then we would have done it.”

Calonge and local health officials said it’s important to keep such information confidential even in the case of a death, in part because of the risk of alienating family and friends who may refuse to cooperate if they feel their loved one has been disparaged.

“We get easier access to information because we do keep it confidential,” Calonge said. “If people think you won’t keep information confidential, they won’t provide it.

“I have real concerns in tuberculosis because we believe that undocumented people don’t seek care because they’re afraid we’ll deport them or report them based on that information. This issue about keeping the information confidential, I believe, is a key cornerstone of public health practice.”

DETAILS

Several conditions, even though not transmitted from person to person, also are reportable, such as plague, West Nile virus and hantavirus.

DETAILS

Some conditions physicians and labs are required to report to the state or local health department include pertussis (whooping cough), hepatitis A, measles, tuberculosis, meningococcus, HIV, gonorrhea, mumps, polio, smallpox, cholera, E. coli and salmonella.