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TB Trends in Larimer County & Changes to the WIC Food List · Healthier Together: Larimer County's Public Health Podcast

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  Welcome to Healthier Together, Larimer County's
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  public health podcast, where we come together
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  for healthier lives, connected communities, and
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  real conversations. From your local public health
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  team, I'm your host, Tom. And I'm Joanna. This
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  is your weekly Minnesota, where we'll provide
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  a brief update on local public health news. Tom,
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  what's up in public health this week? Well, today
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  we have our medical officer, Dr. Paul Mayer,
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  here to talk about recent trends in tuberculosis
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  cases in Larimer County. Dr. Mayer, thank you
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  so much for joining us. I'm very happy to be
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  here today. So to start off, what is TB and what
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  are some symptoms? So tuberculosis is a bacterial
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  disease spread through the air. When somebody's
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  coughing, we breathe in the air that they've
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  been coughing, and in that air, there's some
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  of the bacteria. We basically always get infected
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  through our lungs. Once it's in our lungs, it
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  can spread to other areas of the body, bones,
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  and really basically anywhere in the body. But
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  we basically do always get infected through our
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  lungs. So it sounds like it's spread and it's
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  airborne more than anything. Correct. So how
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  can people prevent the spread of tuberculosis?
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  Well, if the people who have active tuberculosis
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  wear a mask, that's actually quite effective
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  at preventing spread of TB. So who is most at
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  risk of contracting TB? TB is much more prevalent
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  in many countries around the world. The United
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  States, we're lucky that we're a very low prevalence
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  country, but other countries such as the Philippines
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  have rates as high as 600 per 100 ,000. Put it
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  in perspective, the rate in the United States
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  is around 2 .7 per 100 ,000. People who are experiencing
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  homelessness is a high -risk population. People
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  living with HIV, if they have a suppressed immune
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  system, and people who are going to go on to
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  immunosuppressive medications are all at increased
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  risk for acquiring tuberculosis. as well as anybody
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  who's a contact for a known case of active TB.
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  Is there an effective vaccine for TB? BCG vaccine
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  is effective for the purpose for which it was
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  created. It was designed to prevent tuberculosis
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  in infants and young children, especially tuberculosis
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  meningitis, which is a less common but rapidly
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  moving and commonly fatal disease of infants
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  and small children in countries with a high incidence
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  of tuberculosis. So it is effective for that
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  purpose. It is not effective later in life to
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  prevent somebody from getting TB as an older
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  child or as an adult. But for the purpose for
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  which it was created, it is quite effective.
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  We've seen that tuberculosis cases in Colorado
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  have risen pretty significantly since 2025. What
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  do recent and local trends look like in Larimer
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  County for TB? We're very lucky in Larimer County.
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  We are a very low incidence county overall for
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  tuberculosis. And we see typically one or two
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  cases of active tuberculosis a year. And that
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  trend has continued. and has not changed significantly
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  over the last 10 years. Gotcha. Can you explain
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  to me what the difference is between like an
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  active TV case and maybe a latent case? When
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  we get infected with tuberculosis, the vast majority
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  of us will control that bacteria, but it's a
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  curious bacteria. It can live in our bodies for
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  many years, 40 or 50 years. Inactive. And when
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  we get older or become immunocompromised for
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  any other reason, it can then start growing again.
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  And in fact, most TB, around 80 % of all the
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  active cases of tuberculosis in the United States
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  are in people who are infected as children or
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  young adults. lived many years with the tuberculosis
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  in their body, and then it started to grow again
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  once they came to the United States. Active TB
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  is a term for people who are sick with tuberculosis.
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  They'll commonly have symptoms like a cough that
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  lasts an unusually long period of time. Obviously,
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  we all get a cough that lasts a week or two with
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  an illness, but tuberculosis, it'll last a month
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  or more. It'll be associated with fevers of a
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  long duration. unexplained weight loss, and even
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  sometimes blood in your phlegm. Oh, wow. So you
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  can have it for an incredibly long amount of
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  time and not even know that you have TB. Absolutely.
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  Without testing, you would never know. What we
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  don't know and what we don't have tests for is
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  we know that some people, when they initially
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  get infected with tuberculosis, will actually
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  kill the bacteria completely, and there is no
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  living TB in their body. We have no way to know
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  that, though. We can't differentiate them. from
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  the people who have tuberculosis and have controlled
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  it but have not completely killed it. So there
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  is a test for somebody who might have TB that's
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  latent and they're not certain. And maybe, like
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  you said, they're in a high -risk category. They
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  did live overseas for a long period of time in
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  a country that had high TB rates. Is there a
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  test then to determine if they have latent TB?
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  Yes, we have two tests for TB. The one we prefer
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  now is a blood test, commonly called a quantiferin
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  gold. It looks for the antibodies against tuberculosis.
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  and can detect if somebody has been infected
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  and made those antibodies to fight the infection.
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  It's a preferred choice because in people who
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  receive the vaccine you mentioned called BCG,
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  the blood tests will not be positive based on
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  that history of that vaccination. The skin tests,
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  which have been around much longer, will commonly
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  come up positive because of a history of that
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  vaccination. So it becomes difficult in those
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  patients to differentiate whether their positive
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  skin test is from the vaccine. or tuberculosis.
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  And the vaccine is given in high incidence countries,
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  which makes it even a little more confusing to
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  try to decide who needs treatment and who just
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  has a false positive. So it sounds like we're
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  lucky in Larimer County that our rates are relatively
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  low. What has been driving the increase then?
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  That's been looked at a lot, both in the state
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  of Colorado and nationally. And the belief is
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  it's a post -pandemic phenomena where... We've
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  seen a significant increase in migration and
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  travel to countries of higher incidence of tuberculosis
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  after the pandemic. So if somebody does have
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  TB, what does treatment look like for somebody
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  who tests positive? So if somebody has latent
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  TB, meaning no symptoms, the treatment's pretty
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  straightforward. It's a single medicine they
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  take daily for four months. It's usually quite
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  well tolerated and has some medication interactions,
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  but that treatment is really pretty simple. And
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  that treatment is about 90 % effective at making
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  sure they never develop active TB. The treatment
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  of active TB is a much bigger production. We
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  need to use four medications, much more common
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  to have side effects or even toxicity. They have
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  to isolate now for at least five days, sometimes
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  up to a couple of weeks. And so it's a considerable
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  hit on their lifestyle. And also, as mentioned,
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  there can be a lot of side effects from the medications.
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  What does monitoring look like then for somebody
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  who's actively taking those medications for an
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  active TB case? Turns out that our interest is
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  in preventing drug -resistant TB from becoming
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  a common occurrence here in the United States.
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  Because of that, the monitoring is fairly intense.
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  We have staff that will watch them take their
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  medications every day and watch them take their
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  medicines. After a period of time, if the patient
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  is able to, we can switch to video observation,
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  meaning they can take a video of themselves on
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  their phone taking their medication. But that
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  will continue throughout their entire six months
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  of therapy. So what should people know or do
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  to help protect themselves and their families
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  from TB? In general, for persons who are not
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  at high risk, there's not too much they need
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  to do or worry about. It's safe to be in public
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  transportation. It's safe to be in communal gatherings.
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  TB is actually a fascinating disease. It is the
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  number one killer of humans in the world as far
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  as contagious disease. And it is a tragedy in
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  that we have effective cures for tuberculosis.
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  If we diagnose you, we can almost always cure
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  you if we catch it early enough. But it tends
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  to be a disease most commonly associated with
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  resource -poor countries and they don't have
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  the infrastructure or wealth to treat TB effectively.
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  As I mentioned, it's a fascinating disease of
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  humans. We believe it goes back at least 70 ,000
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  years and perhaps millions of years. And they
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  find evidence of tuberculosis in the spines of
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  mummies in Egypt and mummies in Peru, which is
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  evidence that tuberculosis came to the Americas
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  long before the Europeans came here. It must
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  have migrated with the humans as they established
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  residences in North and South America. So Colorado
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  has something of a unique history with TB and
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  TB treatments. Can you tell us a little bit more
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  about that? Yeah, it's a fascinating history.
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  Parts of Colorado were largely settled due to
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  tuberculosis. Before we had effective antibacterials
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  for tuberculosis, the treatment with things like
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  Sunshine, they believed the fresh mountain air
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  was good for TB. So certain areas of Colorado,
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  particularly down in Colorado Springs and in
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  the Denver area, were heavily... due to tuberculosis
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  and the creation of TB sanitariums. We have arguably
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  one of the best lung hospitals in the country
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  and the world in National Jewish down in Denver,
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  and that is largely due to our history with tuberculosis.
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  Thank you so much, Dr. Mayer. We really do appreciate
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  you taking the time to talk to us. Oh, you bet.
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  Anytime. Next, we're joined by the Health Department's
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  Nutrition Manager, Ashley Greer, here to talk
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  about upcoming changes to the WIC food list.
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  Ashley, thank you so much for joining us. To
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  start, can you just explain what WIC is and who
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  it benefits? WIC is the USDA's Special Supplemental
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  Nutrition Program for women, infants, and children.
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  It's a nutrition program that supports pregnant
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  and postpartum individuals, infants, and children
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  under the age of five who qualify based on income
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  and nutrition risk. But it's more than just food.
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  It's nutrition education, breastfeeding support.
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  We also monitor growth and development and connections
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  to community resources. We're really here to
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  support families during some of the most important
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  years of development. What does that food support
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  look like? So the food benefits are a monthly
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  food package that the participants will get that
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  consists of a variety of foods to help meet a
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  healthy lifestyle, such as fruits and vegetables,
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  dairy. breakfast cereals, yogurts. So really
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  a food prescription is what we like to think
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  of it as to help them meet whatever stage of
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  life that they're in at that time. WIC offers
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  food packages, like you've mentioned, as well
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  as a food list that you can shop for at the grocery
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  store. Is that right? Yeah. So the food package
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  is more of those sets of foods based on their
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  Life stage, so pregnant, breastfeeding, toddler,
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  child. And then the food list is more specific.
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  It tells participants what brand, sizes, types
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  of foods that are approved at the store. So if
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  a package has 24 ounces of whole grain, that's
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  part of the food package. And then the food list
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  will tell you exactly which tortillas, breads,
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  pastas, and rice that are actually available
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  to purchase. Okay, that makes sense. So the food
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  list is what's changing effective March 1st.
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  What is changing? Yeah, so there's actually quite
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  a bit of changes coming this year. So all fresh
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  herbs are actually now allowed instead of just
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  certain ones. We're adding new food package sizes
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  to the whole grain category. Cereals must now
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  contain no more than six grams of added sugar
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  per ounce. The 75 % of the cereals on the list
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  have to have whole grain as the first ingredient.
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  So you'll see 17 new whole grain cereals. And
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  there's actually going to be one non -whole grain
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  cereal. So if you like Rice Krispies, those are
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  on the package now. Yogurt is actually seeing
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  the biggest change. About 88 % of the current
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  yogurt list is being removed because it did not
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  meet updated nutrition standards or wasn't purchased
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  enough in the last year. Yogurt has to contain
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  a certain amount of vitamin D and have no more
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  than 6 grams of added sugar per 8 ounces. Plant
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  -based milk options are expanding beyond just
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  soy milk. Tofu has a new calcium requirement,
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  so you'll see new brands and sizes that are being
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  added. There's also new fish options and alternative
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  nut and seed butters. What does the process look
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  like to make those changes, the decision process
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  for updating the food list? USDA looks at the
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  food on the WIC program about every 10 years,
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  and WIC, Colorado WIC, looks at those food lists
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  and shopping guides every two to three years.
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  Many of the changes in 2026 actually came from
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  manufacturers reaching out with new products,
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  and then also submissions from participants through
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  the I couldn't buy this feature on the app. And
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  so when the date gets... submission, they do
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  a deep dive into, does this meet the nutritional
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  standards? And is it a request that participants
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  are wanting? And so if those check all those
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  boxes, then they'll add that in, but they'll
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  also remove food. So if foods don't meet nutritional
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  standards, have been discontinued, or no longer
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  sold in Colorado, those get removed. And actually
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  this year, several hundred were submitted for
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  review during this cycle. But only a small number
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  actually met the strict nutritional requirement.
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  What changes are you most excited about? I'm
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  most excited about the plant -based milk options
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  and also the nut and seed butters. For a long
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  time, soy milk was really the only alternative.
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  And now we're able to offer a few more options.
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  Same thing with the nut and seed butters. Beans
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  was really the only alternative to the peanut
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  butter. This just really helps us to serve families
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  with allergies, intolerances, and personal preference,
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  just making the program a little more inclusive.
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  As you mentioned, the food list requirements
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  are very detailed and they can be kind of confusing
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  and maybe intimidating. You mentioned an app.
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  What tools are available for WIC participants
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  to help navigate the food list? Yeah, so we really
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  encourage participants to use the WIC app. It
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  allows them to scan. the product's barcode at
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  the store. They can refer to the food list and
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  shopping guide for the approved products and
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  sizes, but if they are at the store and they
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  just want to double check that this is eligible,
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  they can pull that up on their app, scan the
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  product's barcode, and then it will pop up green
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  if it's eligible and then red if it's not. The
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  WIC app also tracks their spending, so if they
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  go into the store and bring that up, they'll
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  know exactly what they have left for their benefits
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  for the month. We encourage and recommend checking
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  the packaging sizes. And then, of course, our
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  staff are always happy to help. We'd much rather
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  answer questions ahead of time so that if they
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  get to the store, they're not at the checkout
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  lane and get frustrated. So they can always reach
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  out to us as well. Are there any common food
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  items that people are often surprised to see
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  included or not included in the food list? One
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  of the most common questions we get is whole
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  milk. So we often see that as a personal preference,
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  but the USDA guidelines really recommends low
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  -fat or fat -free milk. So unless medically necessary,
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  we continue to go along with those guidelines.
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  But I would say that's probably the most common
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  question we get. How does WIC impact the local
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  economy? So WIC makes a significant economic
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  impact locally. We partner with 21 local grocery
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  stores. Larimer County. And then in 2025, WIC
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  contributed over $3 .1 million to the Larimer
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  County economy. Those benefits help to support
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  our families, but they're also helping to support
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  these local businesses as well. In your experience,
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  does Colorado WIC differ at all from WIC in different
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  places? It does slightly. The WIC program itself
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  and the participants that we serve and what we're
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  doing at WIC is pretty standard across the board,
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  but we do see some slight differences. I used
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  to be a supervisor in the Wyoming WIC program,
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  and one thing that I can remember that was different
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  from Colorado is that WIC Colorado allows tofu
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  and Wyoming didn't. So those can be a little
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  bit different. The USDA puts in new guidelines
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  for these food packages, and there are some allowances
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  that some states can accommodate, some states
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  can't. So when we were recreating the food packages
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  for Colorado, the USDA overall allowed certain
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  food items, but based on what Colorado can provide
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  and the... programming that we use, they couldn't
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  make all of those. So you may see some food benefits
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  in other states and not others. So that's where
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  I'd say the differences are. With the federal
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  government shutdown back in the news, is WIC
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  concerned about funding? WIC is actually fully
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  funded through September 30th, 2026. So there
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  should be no interruption in services for participants.
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  If anything does change at the federal level,
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  guidance is always provided to the state and
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  local agencies. But really at this time, families
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  can feel confident that benefits will continue
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  as usual. What do you wish more people knew about
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  WIC? I wish more people knew that WIC was not
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  just a formula service. We will provide formula
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  if medically necessary, but we provide so much
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  more. We have access to nutrition education from
• 17:41
  registered dietitian or trained nutrition staff.
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  You really were walking with participants. trying
• 17:49
  to understand what is important for them and
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  helping them to determine nutrition goals that
• 17:54
  they can set and help them achieve positive behavior
• 17:58
  change. How can people learn more about WIC and
• 18:01
  apply? It's a great question. So we have a lot
• 18:04
  of information available. So the USDA website
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  has a lot of information on the WIC program.
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  The Colorado WIC website also has a lot of information.
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  your closest clinic, and that contact information
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  is on there. The Larimer County website has a
• 18:25
  referral form that you could submit to, and that
• 18:27
  sends that referral directly to us. You can also
• 18:30
  submit through Colorado Peak. The referral through
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  there will also come to us and we'll contact
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  you. Thanks so much for joining us, Ashley. To
• 18:40
  learn more about Larimer County WIC and find
• 18:42
  the referral form, visit larimer .gov slash WIC.
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  Do you have a question about public health in
• 18:48
  Larimer County or a topic you'd like us to discuss?
• 18:51
  Let us know. Email us at healthiertogetheratlarimer
• 18:55
  .org. Thanks for listening, Larimer County. Until
• 18:59
  next week, stay well, stay connected, and remember,
• 19:02
  we really are healthier together.