Public Health Institute observes World TB Day

Although tuberculosis is at historic lows in the U.S. and California, the disease remains a worldwide epidemic and poses a threat to everyone who breathes because it is spread through travel and migration. Therefore, in recognition of World TB Day on March 24, the Public Health Institute urges state and local public health departments to continue their vigorous efforts to prevent, monitor and treat this age-old disease.

“TB still kills up to two million people every year worldwide,” said Kathleen Moser, MD, director of TB control for San Diego County and PHI program director for Puentes de Esperanza, a binational TB project in Baja California. “Because people are so mobile, you can’t contain infectious disease in one part of the world. We’re all in this together. As a result, it’s very important to maintain the infrastructure we need to battle this disease every day.”

Continuing a nearly two-decade decline, 12,904 cases of TB were reported in the U.S. and 2,695 cases were reported in California in 2008, the most recent year for which there are statistics. This is the smallest number of cases recorded in the U.S. and California. However, the state reported the largest number of TB cases in the U.S. and the second highest rate of TB infection – 7 cases per 100,000 people; the nation’s rate is 4.2 cases per 100,000 people. What’s more, the rate of decline in TB cases has slowed in recent years both in the U.S. and California.

The disease disproportionately hits foreign-born, disadvantaged and minority populations and people with HIV, whose immune systems are weakened. People born outside the country accounted for 75 percent of the state’s TB cases in 2008, according to the California Department of Public Health. The lion’s share of TB cases are among people who are Asian/Pacific Islander or Hispanic.

Complicating control of TB has been the emergence of strains of the disease that resist treatment by some or most of the medications available. An estimated 440,000 people worldwide have the drug-resistant form of the disease. In California, 28 to 41 cases of multi-drug resistant TB were reported each year between 2002 and 2008; another 23 people were diagnosed with the most challenging strain of the disease, extensively drug resistant TB, since 1993.

Because people with TB must swallow pills for six months to more than two years, some stop taking them when they feel better, tire of the regimen, or, in developing countries, lose access to the drugs. Often, when they fall ill again, the disease has mutated to resist standard medications. Treating people with drug resistance is far more expensive.Puentes de Esperanza is an example of the type of partnership that is needed to stop the spread of this disease globally.

Funded by USAID, the program works to strengthen the public health response for identifying and treating patients who are multi-drug resistant in Baja California. “It’s in the interest of the U.S. to help countries treat their drug-resistant patients at home where there is a lack of infrastructure,” Moser said. “We’re trying to step this up with this border program.”

Once known as the white plague and consumption, TB is preventable and has been curable for more than 50 years. Yet, one third of the world’s people are infected with this disease in its latent or active form and up to 10 percent will develop active disease. Nearly eradicated in the U.S. many years ago, a TB resurgence occurred in the late 1980s and early 1990s, which was brought under control by a public health mobilization that used directly observed therapy to assure that patients adhered to their medication regimens.TB is spread by extended exposure to droplets in the air from an infected person’s coughs, sneezes or talking.World TB Day commemorates the date in 1882 when German doctor Robert Koch identified the bacteria that cause TB. The day is intended to draw awareness to the disease.