Eleven cases of tuberculosis have been detected in Contra Costa County, with most linked to workers and customers at the California Grand Casino in Pacheco, two miles west of Concord, county health officials said Thursday.
The cases date back to 2018, and health officials urge anyone who has been to the casino between 2018 and now to get tested. Recent genetic testing found that 10 of the 11 cases were related. The eleventh case has not yet been genetically tested, but the person also spent time at the casino.
Health officials have not yet identified a current or ongoing source of transmission at the casino. The county first learned of the connection between the cases and the casino in 2021, and this year was notified by the state’s public health department of additional cases linked to the same cluster.
Tuberculosis is a bacterial infection that mainly affects the lungs and most often results in a persistent cough, sometimes with blood, as well as fever, weight loss, night sweats and fatigue. It’s transmitted through the air when someone with TB coughs or sneezes, especially in small enclosed spaces over several hours.
TB can be treated with antibiotics over the course of four, six or nine months, depending on the drug regimen, according to the U.S. Centers for Disease Control and Prevention. Some cases are resistant to antibiotics.
In 2021, about 9% of TB cases in the United States were resistant to isoniazid, one of the most common anti-TB drugs, and 11.3% were resistant to multiple anti-TB drugs including isoniazid, according to the CDC.
A cluster of 11 tuberculosis cases dating back to 2018 has been detected in Contra Costa County, with most linked to workers and customers at California Grand Casino in Pacheco. Shown here, a frontal thoracic x-ray of pulmonary tubercuolsis.
BSIP/Universal Images Group via Getty ImagesCounty officials declined to say whether the 11 people with TB have recovered, nor how severe their cases were, citing privacy concerns.
Many people who are infected don’t show symptoms for months or years, so it’s important that people get tested even if they don’t feel sick, said Dr. Meera Sreenivasan, deputy health officer for Contra Costa County. A latent TB infection, where someone is infected but doesn’t have symptoms, is easier and faster to treat than someone with active TB disease.
The health department has contacted more than 300 people who may have been exposed and are working with casino management to educate staff and encourage testing.
“We are making this recommendation now because there is new evidence that TB may have spread among people who spent time at the casino from 2018 to 2023,” Sreenivasan said. “TB can cause serious illness, but it is treatable and curable with medicine, especially when caught early.”
In California, rates and cases of tuberculosis had been steadily declining since the 1990s and hit an all-time low of 1,703 cases in 2020, the first year of the COVID-19 pandemic. But since then, rates and cases have ticked up, with cases rising 3% to 1,750 in 2021 and then 5% to 1,843 in 2022, according to state data.
Nevertheless, the overall incidence of TB is low in the United States. There has been a vaccine for years, known as the BCG (Bacillus Calmette-Guerin) vaccine, but it is not part of routine childhood vaccinations in the U.S. because of the country’s low rates of TB. Countries with high rates of TB include China, India and the Philippines.
The main way to test for TB is with a skin test, where a small amount of liquid is injected under the skin on the lower arm. After 48 to 72 hours, a bump may develop, and a health care professional measures the bump to determine whether the result is positive or negative. For people who have received the BCG vaccine, the skin test may yield a false positive, so they should get a TB blood test instead, local health officials said.
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Dr. Debi Johnson is a medical expert and health journalist dedicated to promoting well-being. With a background in medicine, she offers evidence-based insights into health trends and wellness practices. Beyond her reporting, Dr. Debi enjoys hiking, yoga, and empowering others to lead healthier lives.
