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TB testing? Positive
> Continued vigilance mandatory if tuberculosis cases, like the one at Northside Hospital, are to remain rare
> Published on: 07/28/05
Though tuberculosis rarely kills in the United States anymore, it still stalks impoverished populations at lethal levels around the world and remains a persistent public health threat domestically, especially in Georgia. The recent case involving an obstetrics nurse at Northside Hospital should be a reminder that TB is far from being eradicated and that efforts to combat the disease will have to adapt to the new face of those who may be spreading it.
Fortunately, no other cases connected to the Northside nurse have turned up, even though more than 200 people (including 37 babies) who may have come in contact with the nurse are being screened. Still, Georgia will record between 500 to 550 TB cases this year — and about 25 deaths. And while the overall TB infection rate within the state continues to decline slowly, the disease has been difficult to eradicate because here, as elsewhere, the demographics of tuberculosis are changing.
In Cobb, Gwinnett, DeKalb and Clayton counties, the infection rate is being heavily influenced by the arrival of illegal immigrants who may have carried the disease with them from other countries. From 1993 to 2003, according to the state's Division of Public Health, the incidence rate among foreign-born Hispanics in Georgia went up 40 percent.
Prior to the immigration influx — and still today in Fulton County — efforts to control TB have been focused on a small number of poor, chronically ill black Georgians, many of them homeless or living in unsanitary conditions. Public health nurses and workers spend a great deal of time and energy on the streets and in shelters with people who have tested positive for TB, often with recurrent cases, to make sure they are taking the drugs necessary to combat the difficult-to-control disease. Those efforts appear to be working, albeit slowly.
The TB cases among immigrants in the surrounding counties, however, present a different picture and one that will need to be addressed in different ways. It's not unusual for the disease to be spread rapidly among immigrants working in close contact with one another in the construction, roofing and road-building trades, physicians say. And immigrants living in crowded housing — especially children living among adults — are also vulnerable to easy transmission of the airborne bacterium. If children become actively infected, they can bring the disease into the schools they attend.
More significantly, foreign-born TB patients are nine times more likely to be infected with multidrug-resistant strains of the disease than are native-born patients. Fortunately, these cases remain very rare in Georgia, but in other parts of the country they are on the rise. Treatment often takes years and is very expensive. (The Centers for Disease Control and Prevention reported recently that in 2002, 73 percent of the 146 multidrug-resistant cases in the United States were among foreign-born patients — another reason why the nation's broken immigration system needs to be reformed, and soon.)
Given the new demographics of TB, public health workers in metro Atlanta will need to target more educational outreach and testing programs at work sites, day labor centers, churches, markets and other places where large numbers of immigrants and their families gather. They will need to enlist the help of the nonprofit sector to work with immigrants, especially those who have never been tested for TB or other communicable diseases.
That effort will not come cheaply. The state currently spends about $6 million a year on TB control. That's probably not enough, considering that one multidrug-resistant case can consume the entire TB control budget of a county health department.
But the alternative is even more frightening: a re-emergence of a disease that is stubbornly resistant to eradication. Without continued vigilance, a case like the one at Northside Hospital will no longer be a rare event in the state, and the outcome could become deadly. _________________ Need Law Enforcement Information? Click here for the Alipac Action Panel
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