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TB cases increase in Montco, Bucks
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By: JO CIAVAGLIA
The Intelligencer

Pennsylvania experienced its largest increase in tuberculosis cases in a decade last year, and hard-to-treat drug-resistant strains are a growing problem statewide.

State Health Secretary Everetta James made the announcement Tuesday - World TB Day - stressing the need to increase public awareness of the contagious disease, also called TB, and the importance of efforts to control its spread.

Last year TB cases in the state jumped from 318 to 345, the largest one-year increase since 1998, state health spokeswoman Stacy Kriedeman said. She added that overall TB rates have declined 23 percent since 1998 when 447 cases were reported.

Bucks County reported 20 active TB cases last year, the highest number in recent memory, said Barbara Schellhorn, director of personal health for the county health department. Since 1999, Bucks had averaged about 14 cases a year.

Montgomery County reported 26 cases last year, up from 23; the county has reported between 23 and 29 TB cases a year since 2003.

Tuberculosis is caused by bacteria that usually attacks the lung, but also can surface in the kidney, spine and brain, according to the Centers for Disease Control and Prevention. The disease is spread most commonly through the air when an infected person coughs or sneezes and people nearby inhale the bacteria.

In developed nations TB is rare. A total of 13,293 U.S. cases were reported in 2007, the lowest rate ever recorded, according to the CDC. Elsewhere the disease remains prevalent. Nearly one-third of the world population is infected, though active disease develops in only a fraction of the people, the CDC said.

Of the Pennsylvania cases last year, 12 percent were resistant to one or more standard tuberculosis medications, according to the state. The trend is worrisome since drug resistance makes it harder and more expensive to treat, and increases the likelihood that people infected with tuberculosis will die.

Drug resistant TB is rising globally with the World Health Organization reporting Tuesday that an extensively drug-resistant strain called XDR-TB has spread to 55 countries and territories worldwide, including the U.S.
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Bucks and Montgomery counties each had two TB cases last year that were resistant to a commonly prescribed antibiotic used in TB treatment, county officials said. None of the cases met the criteria for multi-drug resistant infections.

Foreigners and people who visit countries with high TB rates are among those at greatest risk for the disease.

In the U.S., 60 percent of confirmed TB cases are among foreign-born people, a trend seen in Bucks as well; in recent years more than half the confirmed cases were among foreign-born residents, according to the county health department.

Recent immigrants from areas with high TB rates such as Africa, Asia and parts of Latin America and Eastern Europe and people who've traveled in high-TB regions also are considered high risk.

For more than 10 years, the Bucks health department has done TB skin tests for all children who come into its immunization clinic who are foreign born or who have lived in the U.S. fewer than two years and can't prove previous TB testing. The county also tests local prisoners with no proof of previous testing or treatment.

TB skin tests carry a high rate of false positives, which is why a positive test must be followed up with blood tests and a chest X-ray. It's also the reason testing is typically limited to high-risk populations.

For people with the infection, treatment is an extensive process lasting six months or longer, health experts say.

Clinics or county health departments that receive state and federal funding are required to perform direct observation therapy for all active TB cases, meaning medical staff must watch as patients ingest their medication.

Jo Ciavaglia can be reached at 215 949-4181 or jciavaglia@phillyBurbs.com.

March 25, 2009 02:40 AM

Foreigners immigrants and illegals immigrants are not being checked?

In the U.S., 60 percent of confirmed TB cases are among foreign-born people, a trend seen in Bucks as well; in recent years more than half the confirmed cases were among foreign-born residents, according to the county health department.

Which is why illegal immigration should be stopped immediately. We need to not allow any visas to people who test positive for TB...and require proof of testing for even visitor visas. Allowing millions of illegal immigrant students in our public schools exposes our own children to TB.

the sad and frightening thing is ...school policies usually prohibit children with lice, fevers and any other contagious disease like chicken pox, measles, etc. from attending class or school functions...but the same school districts don't inquire at time of registration regarding TB....so millions of children of immigrants from high-risk areas (whether here legally or not) are allowed in without knowing if they carry TB or not. This is just plain wrong. School disticts should demand a TB test from every foreign born student and/or student who has travelled to high-risk areas or lives with immigrants from high risk areas. It's this ridiculous political correctness that is jeopardizing our nation's health.