Tuberculosis, the scourge thought to be nearly eradicated in the United States, is making a comeback.
Once the nation's leading cause of death, TB began to wane in the mid-20th century due to improvements in diet, hygiene and housing conditions and the development of effective antibiotics that allowed patients to be treated in the community rather that isolated in sanitariums.
The number of reported cases declined yearly beginning in 1953 (when the federal government first collected such statistics).
That is, until 1985. Each year since, the number of occurrences has climbed steadily upward and the disease is now rampant in major cities, particularly among homeless, substance-abusing and immigrant populations.
This upsurge has been compounded by the emergence of a new strain that resists conventional treatment methods and the spread of the Acquired Immune Deficiency Syndrome.
Officials are now looking at reopening long-shuttered residential treatment facilities, resuming mass testing programs and rewriting quarantine laws.
TB is spread through the air in tiny droplets expelled when a person with an active case coughs or sneezes. The bacteria is inhaled by others and usually lodges in the lungs, where it can multiply and cause permanently g lesions.
TB can invade or spread to other organs. Left untreated, it can be fatal.
An opportunistic menace, TB can lie dormant in the body for decades, progressing to the active stage when resistance is low.
The recent resurgence can be attributed to a number of factors, including an influx of immigrants from Third World countries where TB is endemic, increased incarceration rates and economic conditions that have forced many Americans into overcrowded housing and poorly-ventilated homeless shelters where the disease thrives.
An outbreak in Richmond, Calif. two years ago was traced to the city's crack houses, where rooms were tightly sealed to prevent detection of drug abuse by neighbors and police.
"Somebody once said long ago that TB is a social problem with medical implications. That's still true--maybe even more so today," said Hazel Swann chief of TB control for the District of Columbia, which in January began a screening campaign in 43 shelters in January, the nation's first organized effort to combat TB among the homeless.
When the upsurge began, many local health departments had ceased aggressive TB monitoring and no longer had sufficient personnel to track carriers and their contacts. Houston, for example, with more than a million and a half residents, has only four such employees.
Local outreach workers, at risk of contracting the disease themselves, now comb rooming houses, alleys and parks to deliver medication, remind sufferers of doctor's appointments and administer diagnostic skin tests. …