Thread: After 20 years of decline, tuberculosis inches up in U.S.

After 20 years of decline, tuberculosis inches up in U.S.

TB is an airborne infectious disease; one in three people worldwide have latent TB.

By Marsha Mercer Tribune News Service
May 15, 2016 — 7:24pm

Justin Sullivan, Getty ImagesDoctors and nurses wear hoods as they test the seal of N95 respiratory masks during a training at the La Clinica San Antonio Neighborhood Health Center April 28, 2009 in Oakland, California. As the number of swine flu cases in the U.S. continues to rise, doctors and nurses at La Clinica's 26 facilities are being trained to use the N95 respiratory mask to be worn if they come in contact with a patient wo is suspected of having the swine flu or tuberculosis.

A year ago, Laura Hall felt tired all the time, was losing weight and had a bad cough.The 41-year-old Spanish teacher from Shelburne, Vt., went to doctors for three months before they finally nailed the diagnosis: active tuberculosis.

“I was scared. I was horrified. ‘Oh my gosh, how did I get this? Where did I get it?’ “ Hall said in a video about TB survivors’ experiences. “I didn’t think that I could get TB, ever.”

While Hall underwent treatment — isolation at home and a demanding regimen of antibiotics and other drugs — the Vermont Department of Health tested about 500 students and co-workers who might have been exposed to her. Nineteen children and two adults tested positive for latent TB. (People with latent TB aren’t sick or contagious, but they carry a greater lifetime risk of developing active TB.)

Hall’s was one of seven active cases in Vermont last year, up from two the year before. Twenty-nine states and the District of Columbia also reported more active TB cases last year than in 2014, the Centers for Disease Control and Prevention reported in March.

After two decades of steady decline, the number of active tuberculosis cases in the U.S. inched up last year. Hall’s was one of 9,563 TB cases reported last year, up from 9,406 cases the year before. The CDC is still trying to determine the reason for the uptick.

The goal set by the CDC, in 1989, of eliminating TB by 2010 — defined as less than one case in a million people — remains elusive. Even if the trend of declining cases had continued, the United States would not have eliminated TB by the end of this century, the CDC said.

“We are not yet certain why TB incidence has leveled off, but we do know it indicates the need for a new, expanded approach to TB elimination,” said Dr. Philip LoBue, director of the CDC’s Division of Tuberculosis Elimination, in an email.

A dual approach is needed: continue to find and treat cases of disease and evaluate their contacts, as well as identify and evaluate other high-risk persons for latent TB infection, he said.

In Vermont, health officials aren’t sure whether last year’s increase was just a statistical anomaly or the beginning of a trend. In case it is the latter, the state Health Department is considering contracting with an outside firm to help it test contacts for exposure. Last year, the short-handed department brought in health staff from around the state as well as volunteers from the Vermont Medical Reserve Corps to test contacts for exposure.

“We were lucky it wasn’t worse,” said Laura Ann Nicolai, deputy state epidemiologist and head of the tuberculosis control program.

TB is an airborne infectious disease caused by bacteria that spreads through the air, person to person, when someone coughs or sneezes. One in three people worldwide have latent TB, according to the World Health Organization. In the United States, up to 13 million people have been exposed to TB and could develop the disease.

Every year, tuberculosis claims 1.5 million lives worldwide and 500 to 600 in this country.

In the United States, Asians have the most cases and the highest rate of disease - 17.9 out of 100,000 persons. The top five countries of origin for foreign-born TB patients are Mexico, the Philippines, Vietnam, India and China.

Immigrants and refugees are screened for TB and treated before entering the United States. Tourists, students and temporary workers are not screened. The CDC does not recommend across-the-board screening for everyone entering the United States, the CDC’s LoBue said.

Because TB hits some ethnic and racial groups harder than others, TB patients can face discrimination and social isolation. Public health officials worry about finding ways to target high-risk populations with TB education and treatment without stigmatizing those groups.

“Given the stigmatization of TB, our ability to do targeted interactions is limited,” said Dr. Jeffrey Starke, a pediatric tuberculosis physician at Texas Children’s Hospital in Houston. Starke is a member of the federal Advisory Council for the Elimination of Tuberculosis, which makes policy recommendations. “We’ve got to find a nonpejorative way to do it so others don’t perceive discrimination,” he said.

State and local health departments are the front line of defense for a disease that many think has already been eradicated. In the late 1800s and early 1900s, TB was a leading cause of death in this country and Europe. With no cure for the disease, patients were urged to “go west.”

More people flocked to Colorado as TB patients looking for dry air and sun than stormed the state as prospectors during the gold rush. Among them: Doc Holliday, friends with gunslinger Wyatt Earp and a participant in the shootout at the O.K. Corral.

“Colorado historically has been on the forefront of TB work,” said Dr. Robert Belknap, director of the Denver Metro TB program. “At the turn of the century, one-third of the state was here because of TB - seeking care for themselves or family members,” he said.

Some of Colorado’s first hospitals were TB sanatoriums, later closed and repurposed. Local and state support for TB prevention and control remains strong in Colorado, said Belknap, president of the National Tuberculosis Controllers Association.

Today four states - California, New York, Texas and Florida - have more than half the nation’s active TB cases, though they have only a third of the country’s population. The four states have the highest numbers of foreign-born residents. The number of cases in Texas rose 5 percent to 1,334 last year.

“We’re clearly going in the wrong direction,” Starke said.

He pointed out that TB is “a social disease with medical implications” because living conditions put someone at risk. TB is associated with poverty, overcrowding and being born outside the United States.

California, with 2,137 cases in 2015, has more than one in five of the new U.S. cases each year and a TB rate nearly twice the national average. Its TB prevention and control program is the nation’s largest - a $17.2 million annual budget split roughly in half between federal and state general funds, and a 40-person central office staff that works with TB contacts in the state’s 61 local health jurisdictions.

In addition to state TB control efforts in California, local health department programs in the counties of Los Angeles, San Diego and San Francisco also receive federal TB control grants from the CDC. Those grants total $7.7 million this year.

About 2.5 million people are infected with TB in California, but most don’t know it, said Dr. Jennifer Flood, chief of California’s TB control program.
While California has several programs aimed at latent TB, she said, “Smaller states are often challenged to test and treat latent TB” because they lack the resources.

Treating TB patients is labor intensive. To ensure that TB patients complete the course of drugs that lasts six months or longer, Directly Observed Therapy programs require a health care worker - not a family member - to watch patients with active TB swallow every dose. If a patient cannot get to a clinic, a health care worker goes to the person’s home. The worker monitors patients for side effects and other problems.

Care also involves communication and cultural challenges. In Michigan, where the number of active TB cases rose from 105 in 2014 to 130 last year, the health department reaches out to Detroit’s large Arab and Bangladeshi populations. In other parts of the state, Burmese immigrants have different needs, said Peter Davidson, Michigan TB control manager.

“Some local health departments have strong partnerships with translation services. Some rely on a less formal mechanism - a private physician or someone on staff at the hospital who speaks the language,” Davidson said.
The cost of treating an active TB case that is susceptible or responsive to drugs averages $17,000, according to the CDC. Care of patients with drug-resistant TB, which can result from taking antibiotics prescribed before TB was properly diagnosed, costs many times more: $134,000 for a multidrug-resistant patient and $430,000 for an extensively drug-resistant one.
Advocates say TB suffers from a lack of urgency and funding.

“TB isn’t as exciting a topic because it’s been around so long. It doesn’t get as much attention as Ebola and Zika, and its advocates aren’t as active as those for HIV/AIDS,” Belknap said. “We’re jealous.”

The federal Tuberculosis Elimination Act, the chief federal funding for TB programs, is authorized at $243 million a year but has received an appropriation of far less for the last several years - $142 million this year, for example.

Most of the money goes to the 50 states, the District of Columbia, 10 major cities and eight territories in grants under a formula based on the number of cases, their severity and other factors. The grants are used to pay salaries for nurses, doctors and epidemiologists, as well as for education and outreach services. Treatment costs are paid by insurance, Medicaid and state and local governments.

Funding at the authorized level could support research on a vaccine and better drugs and treatment of more cases of latent TB, advocates say. For now, no TB vaccine is approved for use in the United States. The medicines that cure TB and brought down the disease rate were developed in the mid-20th century. They require months of treatment and can have serious side effects, including hearing loss. A promising new drug may be able to prevent TB with only 12 doses over three months.

“The tools we have are inadequate,” Belknap said. “It’s a federal and a global problem.”

In many ways, though, the story of TB prevention and treatment in the United States is one of success.

“We often say we’re our own worst enemy,” said Donna Wegener, executive director of the National TB Controllers Association. “We had such success in reducing TB after the resurgence in the 1990s that people think we don’t need additional dollars.”

Patients with diabetes, cancer and especially HIV infection are more likely to contract active TB because their immune systems are less able to fight off TB germs. During the HIV/AIDs epidemic, from the mid-1980s to the early 1990s, the number of TB cases jumped by 19 percent. From 1992 to 2014, the number of cases dropped 65 percent.

There were nearly as many cases of Lyme disease in Pennsylvania in 2014 (7,457) as there were TB cases in the United States (9,406).

But, Wegener said, “If we were reporting 10,000 new cases of polio a year in the U.S., that would be unacceptable. It’s criminal that we are OK with 10,000 cases of TB.”

Among those infected in the early 1990s was a young physician who volunteered to treat TB patients at a clinic in New York City. He tested positive for exposure but his latent TB did not progress to active disease. Tom Frieden now is director of the CDC, leading the fight against TB.

http://www.startribune.com/after-20-...u-s/379588001/






View Comments

About time to start testing for TB and other contagious diseases on the rise at the boarder, in schools, at social services this needs to be stopped now.

It does not take a nuclear rocket scientist to know the answer for the huge increase in TB.......


It's the Obama's open border jumpers spreading TB and many other third world diseases endangering the
health of every American.

Another Obama Harvard social justice warrior seems to think that his duties are to the world first and the country second. Why are US taxpayers paying the bill for 800 foreign offices while eradicated diseases are now reoccurring in the US? The Surgeon General has the authority to close our borders to protect the health of US citizens if there is a threat of infectious disease. Instead, they treat the disease at, US expense.

Biography of the Surgeon General

Vice Admiral (VADM) Vivek H. Murthy, M.D., M.B.A.

Vice Admiral Vivek H. Murthy was confirmed on December 15, 2014, as the 19th United States Surgeon General. As "America’s Doctor," Dr. Murthy is responsible for communicating the best available scientific information to the public regarding ways to improve personal and public health. He also oversees the operations of the U.S. Public Health Service Commissioned Corps, comprised of approximately 6,700 uniformed health officers who serve in nearly 800 locations around the world to promote, protect, and advance the health and safety of our nation and our world.

Dr. Murthy has devoted himself to improving public health through the lens of service, clinical care, research, education and entrepreneurship. The son of immigrants from India, Dr. Murthy discovered a love for the art of healing early in his childhood while spending time in his father’s medical clinic in Miami, Florida. After attending Miami Palmetto Senior High School, he received his Bachelor’s degree from Harvard and his M.D. and M.B.A. degrees from Yale. He completed his residency training at Brigham and Women’s Hospital and Harvard Medical School where he later joined the faculty as an internal medicine physician and instructor. As a clinician-educator, Dr. Murthy has cared for thousands of patients and trained hundreds of residents and medical students. He regards caring for patients as the greatest privilege of his life.

In addition to clinical practice, Dr. Murthy has two decades of experience and perspective improving health in communities around the world. He co-founded VISIONS, an HIV/AIDS education program in India and the United States, which he led for eight years. As its president, he established ten chapters with hundreds of volunteers in both countries and grew the organization’s education programs to reach more than 45,000 youth. Dr. Murthy also co-founded the Swasthya project (“health and wellbeing” in Sanskrit), a community health partnership in rural India, to train women to be health providers and educators. During his five-year tenure with the organization, he established seed funding and helped expand research and direct care programs that reached tens of thousands of rural residents.

As a research scientist, Dr. Murthy has conducted laboratory research on vaccine development and studied the participation of women and minorities in clinical trials. His research findings have been published in Science, the Journal of the American Medical Association, and the Journal of the National Cancer Institute. Dr. Murthy is also a healthcare entrepreneur and innovator. He co-founded and chaired a successful software technology company, TrialNetworks, which improves research collaboration and enhances the efficiency of clinical trials around the world. Over a period of seven years, Dr. Murthy and his team took the company from conception to an international enterprise that powers dozens of clinical trials for over 50,000 patients in more than 75 countries. Dr. Murthy also served as the president of Doctors for America, a non-profit organization comprised of more than 16,000 physicians and medical students in all 50 states who work with patients and policymakers to build a high quality, affordable healthcare system for all.

As a proven leader who will employ 21st century approaches and technology to modernize the role of the Surgeon General, Dr. Murthy plans to focus his efforts on building partnerships within communities and across numerous sectors of society to address the epidemics of obesity and tobacco-related disease, to reduce the stigma associated with mental illness, to improve vaccination rates and to make prevention and health promotion the backbone of a strong and healthy America. Dr. Murthy firmly believes that our nation's greatest asset has always been its people. And improving the health of the American people – and our neighbors around the world – will be Dr. Murthy’s highest priority as the U.S. Surgeon General.


The official duties

About the Office of the Surgeon General

As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury. In 2010, the Affordable Care Act designated the Surgeon General as the Chair of the National Prevention Council, which provides coordination and leadership among 20 executive departments with respect to prevention, wellness, and health promotion activities.

The Surgeon General oversees the U.S. Public Health Service Commissioned Corps (USPHS), an elite group of more than 6,700 uniformed officer public health professionals working throughout the federal government whose mission is to protect, promote, and advance the health of our nation.
The Surgeon General is nominated by the President of the United States with advice and consent of the United States Senate for a four-year term of office. The Office of the Surgeon General is part of the Office of the Assistant Secretary for Health in the U.S. Department of Health and Human Services.
Vice Admiral Vivek H. Murthy, M.D., M.B.A., serves as Surgeon General and Rear Admiral Sylvia Trent-Adams, Ph.D., R.N., F.A.A.N., serves as Deputy Surgeon General.

http://www.surgeongeneral.gov/about/...ies/biosg.html

Appoint Dr. Ben Carson as Surgeon General...slam the border door shut!

by MICHAEL PATRICK LEAHY
17 May 2016
796 comments

One of every five refugees resettled in Minnesota by the federal government tested positive for latent tuberculosis in 2014, according to the state’s Department of Health.

Only 4 percent of the general population in the United States tested positive for latent tuberculosis in the most recent report provided by the Centers for Disease Control.

The April 2016 edition of the Refugee Health Quarterly, published by the Minnesota Department of Health reports that:

Minnesota had 150 cases of TB in 2015, compared to 147 cases in 2014 (a 2 percent increase). The most common risk factor for TB cases in Minnesota is being from a country where TB is common.

TB screening is offered to all refugees during the domestic refugee health exam.

In 2014, 22 percent of refugees screened tested positive for LTBI (latent tuberculosis infection).

26 percent of all foreign born cases of tuberculosis in Minnesota were from people born in Somalia. Somalians almost exclusively enter the state through the refugee resettlement program.

More than 70,000 refugees have been resettled in the United States annually for the past three decades by the federal government. It’s not just tuberculosis being brought in by these resettled refugees. Measles, whooping cough, diptheria, and other diseases that were on their way to eradication are also coming in across the borders of the United States.

A recent outbreak of measles in Memphis, Tennessee, a center for refugee resettlement, began at a local mosque, as Breitbart News reported previously.

The alarming public health report from Minnesota comes on the heels of news from the Centers for Disease Control that in 2015, the incidence of tuberculosis in the United States increased.

“Data from 2015 show that the number of TB cases has increased (by 1.7 percent) nationally [in the United States] for the first time in 23 years, with a total of 9,563 TB cases reported,” the Minnesota Department of Health reports.

As the Star Tribune, Minnesota’s largest daily newspaper, reports:

The CDC is still trying to determine the reason for the uptick.

The goal set by the CDC, in 1989, of eliminating TB by 2010 — defined as less than one case in a million people — remains elusive. Even if the trend of declining cases had continued, the United States would not have eliminated TB by the end of this century, the CDC said.

“We are not yet certain why TB incidence has leveled off, but we do know it indicates the need for a new, expanded approach to TB elimination,” said Dr. Philip LoBue, director of the CDC’s Division of Tuberculosis Elimination, in an email.

A dual approach is needed: continue to find and treat cases of disease and evaluate their contacts, as well as identify and evaluate other high-risk persons for latent TB infection, he said.

There may be a positive correlation between the increase in the number of refugees resettled in the United States during this period and the sudden increase in the incidence of tuberculosis, a disease that many thought was on the path to eradication in the United States.

As the Centers for Disease Control report:

In 2014, a total of 66% of reported TB cases in the United States occurred among foreign-born persons. The case rate among foreign-born persons (15.4 cases per 100,000 persons) in 2014 was approximately 13 times higher than among U.S.-born persons (1.2 cases per 100,000 persons).

“Today four states – California, New York, Texas and Florida – have more than half the nation’s active TB cases, though they have only a third of the country’s population. The four states have the highest numbers of foreign-born residents,” according to the Star Tribune.

A person with latent tuberculosis is not infectious and does not have symptoms of the disease. A person with active tuberculosis is infectious and has symptoms of the disease.

Ten percent of those with latent tuberculosis develop active tuberculosis if not treated, according to the World Health Organization.

As the Star Tribune reports:

TB is an airborne infectious disease caused by bacteria that spreads through the air, person to person, when someone coughs or sneezes. One in three people worldwide have latent TB, according to the World Health Organization. In the United States, up to 13 million people have been exposed to TB and could develop the disease.

Every year, tuberculosis claims 1.5 million lives worldwide and 500 to 600 in this country.

“Tuberculosis (TB) has surpassed HIV as the leading cause of death from infectious disease worldwide,” the Minnesota Department of Health reports.

Tuberculosis is airborne and can be spread when a person active tuberculosis coughs, sneezes, or otherwise transmits the infection to a previously uninfected individual.

Treatment for tuberculosis is long and expensive. If caught early, it typically takes about nine months for a person with active tuberculosis to improve to latent tuberculosis. Not everyone diagnosed with active tuberculosis, however, improves. Mortality rates for those with active tuberculosis are much higher than health professionals would like, even in the United States.

According to the Star Tribune:

Treating TB patients is labor intensive. To ensure that TB patients complete the course of drugs that lasts six months or longer, Directly Observed Therapy programs require a health care worker – not a family member – to watch patients with active TB swallow every dose. If a patient cannot get to a clinic, a health care worker goes to the person’s home. The worker monitors patients for side effects and other problems.

Care also involves communication and cultural challenges. In Michigan, where the number of active TB cases rose from 105 in 2014 to 130 last year, the health department reaches out to Detroit’s large Arab and Bangladeshi populations. In other parts of the state, Burmese immigrants have different needs, said Peter Davidson, Michigan TB control manager.

“Some local health departments have strong partnerships with translation services. Some rely on a less formal mechanism – a private physician or someone on staff at the hospital who speaks the language,” Davidson said.

The cost of treating an active TB case that is susceptible or responsive to drugs averages $17,000, according to the CDC. Care of patients with drug-resistant TB, which can result from taking antibiotics prescribed before TB was properly diagnosed, costs many times more: $134,000 for a multidrug-resistant patient and $430,000 for an extensively drug-resistant one.

Minnesota public health officials point to the high treatment rate of those refugees diagnosed with latent tuberculosis as a reason for optimism.

“Eliminating TB in the U.S. will require increased attention to the diagnosis and treatment of latent TB infection (LTBI),” the April 2016 Refugee Health Quarterly reports.
“Minnesota’s LTBI treatment completion rate for refugees who start treatment is one of the highest in the nation at 86 percent in 2013,” the report adds.

An alternative public health policy–one that the United States used for decades in the latter part of the nineteenth century and early twentieth century–is to test immigrants and refugees for infectious disease before they are allowed into the country.

In that earlier era, those who tested positive were sent home. Today, however, many are welcomed in and pose a risk of infecting the rest of the American population.

http://www.breitbart.com/big-governm...-tuberculosis/

22% Resettled Refugees Are TB Positive, 1 in 5 - 2014 Report

Obama wants $1.9 billion of OUR money for Zika Virus, billions for Ebola. Now he is going to cause a MASSIVE outbreak of TB and other respiratory diseases in our schools and in our country that will cost billions more of our dollars, affecting our health! Not to mention what the Muslims are bringing over...STD's that we have not seen in decades. Just look at Europe. And all these illegals will be getting FREE care, paid for by US taxpayers!

Send them ALL back.