FP Plays Key Role in Stopping TB Outbreak

Erin Corriveau, M.D., M.P.H., went to Paris — for a health conference.

Corriveau took a five-month academic sabbatical this summer and fall from her role as associate professor in the departments of Family Medicine and Community Health and Population Health at the University of Kansas Medical Center to expand her knowledge of treating patients with tuberculosis. During that time she continued to work in her roles as deputy medical officer for Wyandotte County (which includes Kansas City, Kan.),  medical director of the county’s tuberculosis division, and a TB physician consultant with the Kansas Department of Health and Environment.

“I’m working,” she said. “I call it my ‘kind of’ sabbatical. It’s been a good opportunity to focus and learn.”

That learning included work abroad, a mini-fellowship, teaching at conferences and her trip to Paris in November for the World Conference on Lung Health. That event, which is sponsored by the International Union on Tuberculosis and Lung Disease, drew attendees from more than 140 countries.

According to the World Health Association, 1.3 million people died from TB in 2022. In the United States, deaths due to tuberculosis fell to below 500 per year in 2014 and 2015 but surged to 600 or more in 2020 and 2021. The continued climb in active TB incidence both locally and abroad is thought to stem from underdiagnosis and overwhelmed health care and public health systems during the COVID-19 pandemic, Corriveau said.

Tuberculosis became a focus of Corriveau’s work in 2021 when Kansas City, Kan., had the nation’s largest recent outbreak of drug-resistant TB. Patients ranging from infancy to age 60 were scattered in multiple hospitals on both sides of the Kansas-Missouri state line.

“We were having difficulty pulling together all the health information of the families and doing the contact investigation work,” she said. “Drug resistant TB is a very, very serious illness. We absolutely had to find and treat everybody who has active disease and then also find all those with latent infection and get them treated, too, in order to prevent future cases of illness and also to stop the spread of TB in our community.”

A CDC health official deployed to the area told Corriveau that her community would need her for the long term.

“He said, ‘We need a doctor who can see all of these patients, take them through six months to a year of treatment, keep eyes on them every single day during that time and then follow them up continuously for two years after that outbreak,’” said Corriveau, who received the AAFP’s Public Health Award in October during the Congress of Delegates in Chicago. “TB work is tough but also really rewarding. It’s not like more traditional office-based primary care, ‘Please take this medicine and we’ll check in together in a few months.’ People were extremely ill, and several almost died. Some still have really severe consequences from their TB illness. Although every single one of our patients lived and completed their treatment successfully — a big success — it was still really difficult because our patients already had very difficult lives. When the CDC came out, they said, ‘A family physician is perfect for this type of work.’

“At that point,” she added with a laugh, “I didn’t know enough about TB to say no.”

Corriveau said she learned a tremendous amount from that CDC official as well as experts from the Heartland National Tuberculosis Center of Excellence in Texas who supported her on a regular basis throughout the outbreak.

An investigation revealed a close genetic relationship to the strain of tuberculosis in Kansas City to isolates from previous outbreaks in the Federated States of Micronesia in 2007—2009 and in Guam from in 2009—2016. Some of the Kansas City patients had lived in Micronesia and Guam during the earlier outbreaks.

People born on Guam, a U.S. territory, are U.S. citizens. Micronesians are not U.S. citizens or nationals, but they are able to live and work in the United States as “nonimmigrants” under the terms of a Compact of Free Association. Although that compact makes it easier for Micronesians to come here, Corriveau said the policy may be a disadvantage to them in some ways because they do not receive the same health checks as refugees or immigrants from many other countries.

Corriveau traveled to Micronesia with the CDC during her sabbatical to work with the agency as it conducted a nationwide sweep in an effort to test, diagnose and treat as many residents with latent and active TB as possible.

She’s also done her best for her Pacific Islander patients in Kansas City.

“During the first couple of months of the TB outbreak, I thought, ‘Oh, my gosh. I can’t wait until I can just get back to my normal routine,’” said Corriveau, who practices outpatient and inpatient family medicine. “Then something happened about six months in where I just fell in love with the patients and the work. I realized all of these people have very full lives that they’re living, but none of them had had any preventive care, primary care or a family doctor, so our team started to get creative about all the ways we could help. We hired a social worker, a community health worker, we hooked the patients and their families into all sorts of care and social services because they were dealing with more than just drug-resistant TB, often including illiteracy, food insecurity, poverty and other hardships.”

Most of the patients she treated for TB have become her patients “for the long haul.”

“It became such a great pleasure to get to know these families — to sing with them, share a meal, talk about health and well-being overall,” she said.

Corriveau was senior author of a CDC Morbidity and Mortality Weekly Report article about the outbreak that was published this fall. She also presented on related topics at the Mayo Clinic in Minnesota; the National Tuberculosis Center in Houston; the CDC’s National TB Conference in Atlanta; and the CDC’s Pacific Islands TB Controllers Association Conference in Hawaii.

As Corriveau meets with tuberculosis exports at home and abroad, she sees a common thread.

“It’s a kind of a small, niche community that is ever interested in growing because they’re taking action to combat TB — the biggest infectious disease killer the world has ever known,” she said, “but what’s amazing is how welcoming they are to physicians in primary care. There’s a recognition that family physicians add a lot. We represent the front line, and then we’re also on the back end of everything, right? Like the follow-up from every hospitalization. There’s a lot of attention to things like post-tubercular lung disease. We’re going to be managing this stuff, so I’m helping to shine a light on how important some of that work is so that as family docs, we can do our best to contribute to this awesome effort.”