Magazine article The Nation's Health

Tuberculosis Rates Level off, but Drug Resistance a Concern: More Research, Funding Called For

Magazine article The Nation's Health

Tuberculosis Rates Level off, but Drug Resistance a Concern: More Research, Funding Called For

Article excerpt

For the first time since the World Health Organization declared tuberculosis a public health emergency more than a dozen years ago, the global epidemic has leveled off.

Yet such encouraging news isn't reason for an all-out celebration, global health leaders said in March, because the disease is still a leading killer worldwide, and drug-resistant TB strains continue to be a serious concern.

"We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden," said United Nations Secretary-general Ban Kimoon. "Almost 60 percent of TB cases worldwide are now detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners. But the disease still kills 4,400 people every day."

WHO reported 8.8 million new TB cases in 2005, with 7.4 million of them in Asia and sub-Saharan Africa. That year, 1.6 million people died of TB, including 195,000 people living with HIV/AIDS.

In a global TB control report released in March in conjunction with World TB Day, WHO officials said TB incidence rates were stable or in decline worldwide, but the total number of new TB cases was still rising because of population growth and continued outbreaks in the African, Eastern Mediterranean and Southeast Asia regions.

U.S. TB cases reach an all-time low

In the United States, TB rates reached an all-time low in 2006, but drug resistance presents "significant challenges to treatment and control of the disease," according to two recent articles in Morbidity and Mortality Weekly Report.

In 2006, there were 13,637 reported TB cases in the United States, down from 14,085 the previous year. While the 2006 national TB case rate, at 4.6 per 100,000 people, was the lowest since reporting began in 1953, the 3.2 percent decline in the national TB case rate from 2005-2006 was one of the smallest declines in more than a decade. The annual drop in the national TB rate slowed from 7.3 percent yearly from 1993 to 2000 to 3.8 percent from 2000 to 2006. As with many health conditions, TB hits harder in minority and low-income U.S. communities.

"The findings are unfortunately not totally unexpected when you look at the history of tuberculosis in the United States," Kenneth Castro, MD, director of the Centers for Disease Control and Prevention's Division of Tuberculosis Elimination, told The Nation's Health.

That history, Castro said, goes back to 1972, when categorical grants for TB control ended in favor of block grants that allowed states to decide where to spend their public health dollars. In many states with budget shortfalls, money previously spent on TB outreach and control went to other areas of need.

In New York, for example, chest clinics closed, outreach workers shifted to other public health priorities and "proficiency among public health workers was lost," Castro said.

Then came the AIDS epidemic, when people with compromised immune systems became vulnerable to catching and spreading TB. At the same time, immigration increased from countries with historically high TB rates. Meanwhile, drug-resistant strains of TB continued to emerge, including strains resistant to multiple drugs.

But TB control rebounded after public health leaders and policymakers developed a national action plan to combat multi-drug resistant TB, Congress allocated money for TB control and people with HIV were routinely screened for TB infection. The drop in the rate of decline for TB rates in the past few years is a result of "a return to the complacency where state TB programs are telling us (that) funding levels, if not flattened, have been reduced," said Castro, a long-time APHA member.

"You know what happens when people are being asked to do more with less," he noted. …

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