Investigation turns up TB at poultry plant
Chicken plants attract foreign-born workers
Poultry processing was front and center at this year’s TB Controllers Workshop, and not because chicken was the main dish on TB controllers’ lunch menus. The workshop, held in Atlanta in August, devoted one of its two days to the subject of contact investigations. If presentations at the workshop are any indication, TB controllers will spend more and more time in poultry plants, long a magnet for foreign-born workers willing to pluck, chop, and risk carpal-tunnel syndrome for the promise of steady wages.
Maine’s example, for starters, was a doozy. According to Steven Shapiro, state public health adviser to the TB control program, trouble began when an Eastern European worker on the day shift of a poultry-processing plant turned up with active disease. The man’s co-workers included a mix of immigrants speaking 30 different languages, plus some American-born workers.
Many workers were supplied by a "temp" agency, with the result that they worked two or three days and departed without a trace. Plus, many employees had had BCG vaccinations, and few had health insurance.
Resistance from all sides
Trouble arose on every conceivable side, says Shapiro. First, with so many uninsured workers, chicken plant executives balked at the thought of getting stuck with the tab for so many skin tests and chest X-rays. Plus, there was no handy site nearby where skin testing could be performed.
As for the American-born workers, they grew resentful, suspicious, and angry as the investigation unfolded. Eastern European immigrants, meanwhile, were certain they were adequately protected against the threat of TB; after all, they’d had BCG vaccinations, hadn’t they?
TB controllers went to work. They scoured communities of immigrants for interpreters. They talked plant management into providing a site for skin testing and then cajoled them into supplying vans and time off for trips to the health department for chest X-rays. They met repeatedly with American-born and foreign-born employees.
The moral? "We learned we needed to be involved," says Shapiro. "We learned communication and creativity are essential and that you’ve got to plan actively and be assertive."
It’s a good thing, too. The poultry plant in question "seems to be a magnet for TB cases," says Shapiro. Since the first case, there’s been a second, not linked epidemiologically but with its own complicated story; a third, again, unlinked; and now, it appears, a fourth case.
"We’re thinking about using the plant as a demonstration project to provide ongoing testing and treatment for latent TB infection," Shapiro says. "Obviously, we’re identifying a lot of cases there, when you consider if we get even two cases a year, that’s 10% of our typical annual morbidity."
Cut to Alabama, where another investigation at a chicken-processing plant unfolded somewhat more smoothly. "I’d have to say that this investigation went better than any we’ve done of this kind," says Nancy Brooke, MPH, director of state TB control.
Some of the elements were the same as the incident in Maine. The index case was Hispanic, with a history of a BCG vaccination. In this case, however, the employee was a member of a stable community of other Hispanics who’ve settled in the area. Because the worker shared a common space in the facility with others, and because he’d routinely rotated through day and night shifts, TB controllers decided to test all 700 workers.
Support from the top
Despite the mammoth size of the investigation, plant bosses cooperated fully, Brooke says. Plant managers posted notices, sent home announcements in paychecks, provided places and times for educational meetings and screenings, and helped ensure that workers complied when it came time to have their skin tests read.
One reason, she says, has to do with the fact that at the outset of the investigation, TB controllers bypassed local management and went straight to the top. "In the past, we didn’t always do it that way. This made a big difference in terms of the control and cooperation."
Because TB controllers had been thinking about doing targeted testing at the plant anyway, they decided to bill the screening as just that, with the result that almost no one guessed they were being evaluated as a contact, says Brooke. "We were determined to protect the confidentiality of the case, and we’d been thinking about targeted testing, and it worked out to our advantage," she says.
She also credits the local TB staff of "intervention specialists," the state’s name for outreach workers, all of whom must have four-year degrees. "They really went the extra mile," she says. "They met with people one-on-one, and they met with groups. They met until everyone understood what needed to be done. They were absolutely dedicated."
One of the intervention specialists, luckily, spoke Spanish, lived in the area, and knew the community. Though workers spoke assorted dialects, everyone got the message in the end: Of 104 people for whom treatment for latent TB infection was prescribed, an impressive 99% have completed the treatment, says Brooke.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content