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  1. #1
    Senior Member legalatina's Avatar
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    San Jose CA: highest rate of TB in the nation ...why?

    Global connections make Silicon Valley a portal in deadly worldwide TB epidemic
    By Mike Swift
    Mercury News
    Article Launched: 04/18/2008 04:11:10 PM PDT

    highest TB rate of any county in California - quadruple the U.S. rate.

    From the bodies of Peruvian mummies to 21st-century tech workers, tuberculosis has been mankind's dark partner for centuries - a highly infectious disease that never followed the path to eradication of smallpox and polio. One in three people worldwide are infected, and 1.7 million died last year, mostly in poor countries where people lack the access to detection and treatment available in the United States.

    No case of TB is easy. The waxy-sheathed, rod-shaped, slow-growing bacteria, if untreated, colonizes the lungs, creating such dense cavities of disease that pieces must sometimes be excised. TB spreads through the air; untreated, one person infects 10 to 15 people a year, according to the World Health Organization.

    But among public health officials, nothing is more worrisome than the relative handful of drug-resistant TB cases. WHO and U.S. experts are warily watching the record level of such cases - found from former Soviet prisons to remote provinces in China - as hints of something even scarier on the horizon.

    "It worries me that we're going to have increased cases of multi-drug resistance because we have no control over the rest of the world," said Dr. Marty Fenstersheib, the public health officer for Santa Clara County, which has had a 21 percent jump in TB cases since 2005. "The person on the street, when you go up to them and say, 'Do you know what one of our major problems is?' and they guess everything else and you go, 'Tuberculosis,' and they go, 'No. We still have TB? We have that?' "

    Treating one drug-resistant case can easily cost several hundred thousand dollars or more - the bill often ends up with the county health department if a patient lacks insurance. And in a growing number of extremely resistant cases - including a few in the Bay Area - there are no drugs that can cure the disease, raising the specter of an infectious, incurable, potentially fatal infection.

    With California in a budget crisis - and the state's total number of TB cases declining - a disaster which hasn't happened yet is not a high priority for politicians. But that is precisely what worries Bay Area TB officials. They say emerging drug resistance, global travel connections, and Gov. Arnold Schwarzenegger's plans to cut TB spending will all handicap California's ability to protect residents from dangerous drug-resistant TB.

    "It drops our pants around our ankles," Alameda County TB control officer Dr. Robert Benjamin said of the budget cuts. "And we can't run like that."

    Demographics: Valley's strong links to other countries

    If affluent, modern Silicon Valley seems an unlikely hunting ground for a disease often presumed a medieval scourge, nothing could be more wrong. This region has intimate ties to countries with the world's highest TB burdens, countries where the lack of access to antibiotics and basic health care has allowed the disease to flourish in the 21st century.

    Ninety percent of Santa Clara County's 241 TB cases in 2007 were in students, immigrants, temporary workers, tourists and others born in other countries. At the same time, the number of multi-drug-resistant cases in the county - bacteria resistant to isoniazid and rifampin, the first-line TB antibiotics - jumped from two to seven.

    The top five countries of origin for foreign-born people with TB are Mexico, the Philippines, Vietnam, India and China, according to the CDC. Those nationalities are also Santa Clara County's largest five foreign-born populations. At 430,000 people, they are one-quarter of the county's total population.

    "Our TB reflects the countries of origin that our patients come from, and it's the Philippines and Vietnam and India where there is a lot of drug resistance," said Dr. Sundari Mase, Santa Clara County's former TB control officer, now with the CDC.

    Many are not recent immigrants - two-thirds of Santa Clara County's foreign-born cases have been in the United States for at least five years. In that sense, TB is a public health issue, not an immigration issue, heath officials say.

    State health officials estimate there are 2 million foreign-born residents of California infected with latent TB. The great majority will never get sick, but if their immune systems weaken - by way of HIV infection, diabetes, aging or immune-suppressing drugs - their TB could multiply, and they could transmit the disease.

    In 2005, soon after she gave birth to a son, the young immigrant wife was hospitalized with TB. In her native Mongolia, she had nursed an older sister, who ultimately died of TB, just before she emigrated to the United States and got married.

    Soon something was ominously clear - Battsengel, who asked that her last name not be used because of her embarrassment at having TB - had a drug-resistant case. It forced doctors to use second-line drugs that can cost 100 times more than standard antibiotics. And they can produce terrible side effects.

    Drug-induced nausea chopped her weight from 110 to 87 pounds. She had ringing in her ears and her feet became numb because of nerve myopathy - a common side effect of second-line TB drugs. And the beautiful skin on the young mother's face was covered by a rash.

    "I was very depressed. There was no happiness, no smile," she said. "Because of my depression, sometimes I would get so angry - sometimes I would try to jump out of home, not try, but I say if I die, it will be better."

    Loopholes: Screening isn't always effective The United States screens legal immigrants and refugees for TB before they are allowed to enter the country, by checking family histories and requiring a chest X-ray for those at risk. But Bay Area health officials say there are loopholes in the nation's defenses, and that budget cuts will only make the gaps bigger.

    Denise Ingman, who heads Montana's TB program, learned about one of those loopholes first hand in summer 2006. Ingman used a new genetic test developed by the California Department of Public Health to confirm a 20-year-old at the University of Montana had potentially infectious drug-resistant TB.

    But the student, who was from Mongolia, probably never would have been able to enter the United States if the country, like Canada, had a system to screen students, temporary workers on H-1B visas or other visitors who may live here for years on non-immigrant visas.

    Once she had the confirmation, Ingman contacted county health authorities who were tracking the student.

    "They said, 'Oh. We just gave her permission to go on a little trip,' " Ingman recalled.

    For three tense days, Montana officials searched for the student, who was on a driving tour of the Pacific Northwest. Her family had their cell phones off. Ingman contacted the Seattle airport, issuing a "do not board" order, because she was worried the student was trying to return home.

    Ingman and the TB control officers in Santa Clara, San Mateo, San Francisco and Alameda counties, as well as the executive director of the National Tuberculosis Controllers Association, agree the United States should screen all long-term visitors.

    Canada prevents an estimated 600 TB cases a year by screening everyone who plans to stay in the country permanently, for longer than six months if they arecoming from a country with a high incidence of TB, or for any length of timeif they will be working in health care, education, child care or domestic work, said Dr. Edward Ellis, manager of TB control for the Public Health Agency of Canada.

    "During the dot-com boom, we in Alameda County and I know other Bay Area counties saw a dramatic increase in tuberculosis among the (H-1B) visa immigrants," said Benjamin, the Alameda TB control officer. "I don't know how or why, but at some point a decision was made by the State Department that if a U.S. company sponsors a highly educated, highly skilled worker, that they don't need screening. . . . I think that just because they are highly educated and have a job doesn't mean they can't have TB."

    The cost of every TB case to local taxpayers is significant.

    Santa Clara County spent an average of $18,000 a case in 2007 - about $4.3 million total - for drugs, testing and for the labor-intensive contact investigation required for families, co-workers or schoolmates who have contact with an infectious person.

    With state and local funding in doubt, Fenstersheib, the county health officer, went to Washington in March to lobby Silicon Valley's congressional representatives to have Santa Clara County join the dozen U.S. cities and counties that get direct federal TB funding.

    "I think we deserve it," Fenstersheib said. "We have more cases than half the cities that have direct funding."

    Emotional toll: S.F. executive's unexpected fight Scott Halstead is an optimistic, athletic person - the kind of guy who would bike several hundred miles a week - a Silicon Valley executive and venture investor.

    In January, five months before his wife was due to deliver their first child, Halstead, the former chief executive of WageWorks in San Mateo, learned he had TB. He didn't have a drug-resistant case, but for 3 1/2 weeks, he was required to stay in his Noe Valley home, going outside only in a surgical mask.

    Instead of business meetings and dinners with his wife, his schedule was tied to the daily arrival of a San Francisco health worker, who would deliver his medicine and watch him take it - a public health requirement to make sure he took all his doses to prevent the survival of drug-resistant bacterial in his body. The drugs fogged his mind to the point he couldn't work.

    And he had to call several business contacts and the relatives he shared Thanksgiving with, and tell them that they all needed to get tested for TB.

    "It's hard to even connect to what it was like to be well," he said.

    Halstead probably was infected on his honeymoon in Africa last year, and immune-suppressing arthritis drugs allowed his TB to multiply. He expects to be in good health by the time his wife delivers later this spring.

    For patients with a multi-drug-resistant case, however, the medical odyssey can be much, much longer.

    Battsengel survived hers. After two years, two months and 15 days of medication, she is healthy, her TB cured after two years of treatment.

    "I feel great," said Battsengel, who is studying to become a nurse. "I have a smile on my face. I have a future."

    One TB patient who spent most of the past three months in Stanford Hospital - a 30-year-old Sunnyvale woman who flew from New Delhi to San Francisco International Airport with a contagious case of multi-drug-resistant TB in December - faces a similar trial. The case triggered a national hunt by the CDC for 44 other passengers or sitting nearby.

    At least one person on the flight might have been infected, although it's impossible to definitively confirm that the infection came from the airline exposure at this point, the CDC reported Wednesday. The Sunnyvale woman, who declined an interview request and whose identity is being withheld by public health officials, is enduring what Fenstersheib said could be a two-year regimen of drugs with potential side effects including hearing and liver damage.

    TB experts say she won't be the last person to bring a dangerous strain of drug-resistant disease to the Bay Area.

    International hubs are at "very, very serious risk," said Dr. Marcos Espinal, who heads the World Health Organization's Stop-TB Partnership Secretariat in Geneva.

    "TB is endemic in many countries that have a strong relationship with the U.S., in trade, exchanges in the arts, in sports," Espinal said. "Many people from those countries meet in the U.S. It's very serious in my view."

    Contact Mike Swift at mswift@mercurynews.com or (40 271-3648.

  2. #2
    Senior Member cvangel's Avatar
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    The first part of the article was missed:
    By Mike Swift
    Mercury News
    Article Launched: 04/18/2008 04:11:10 PM PDT


    Click photo to enlarge
    Registered nurse Eileen Choy works in the tuberculosis clinic at San... (Dai Sugano / Mercury News)«12345»
    Interactive
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    In a beautiful home filled with mementos of world travel, a 44-year-old Silicon Valley executive reluctantly picks up the telephone to tell several business contacts that he might have infected them with tuberculosis.
    In a one-bedroom apartment in Oakland, a new mother feels her life slipping away. She is losing her hearing, her feet are going numb and her face carries a rash from the toxic drugs being used to fight the drug-resistant bacteria in her lungs. Her body has dwindled to 87 pounds and she wonders: Would my husband and infant son be better off if I was dead?

    In Helena, Mont., the state's tuberculosis official takes an urgent call from the laboratory and feels her stomach knot. She has a patient with a potentially infectious, dangerous TB strain - a case her state lacks the money and the medical resources to treat.

    Those three small snapshots are all part of a global tuberculosis epidemic that threatens the Bay Area - with its web of international connections - like few places in the nation.

    Call it one price of globalism.

    Last year, tuberculosis increased in four of the Bay Area's five largest counties, and the San Jose area in 2006 had the highest TB rate of any large American metro area, according to data from the U.S. Centers for Disease Control and Prevention and the California Department of Public Health. San Francisco, after an outbreak of TB among Latino dayworkers in the Mission district, has the highest TB rate of any county in California - quadruple the U.S. rate

    and here's a link:

    http://www.mercurynews.com/news/ci_8975501

  3. #3
    Senior Member Gogo's Avatar
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    WAIT JUST ONE MINUTE HERE:

    The top five countries of origin for foreign-born people with TB are Mexico, the Philippines, Vietnam, India and China, according to the CDC. Those nationalities are also Santa Clara County's largest five foreign-born populations. At 430,000 people, they are one-quarter of the county's total population.

    "Our TB reflects the countries of origin that our patients come from, and it's the Philippines and Vietnam and India where there is a lot of drug resistance," said Dr. Sundari Mase, Santa Clara County's former TB control officer, now with the CDC.

    Many are not recent immigrants - two-thirds of Santa Clara County's foreign-born cases have been in the United States for at least five years. In that sense, TB is a public health issue, not an immigration issue, heath officials say.

    State health officials estimate there are 2 million foreign-born residents of California infected with latent TB. The great majority will never get sick, but if their immune systems weaken - by way of HIV infection, diabetes, aging or immune-suppressing drugs - their TB could multiply, and they could transmit the disease.

    ARE YOU TRYING TO TELL ME ALL OF THESE PEOPLE HAD ENTRANCE HEALTH EXAMS? I THINK YOUR A LIAR SIR. WHY DON'T YOU CHECK THEIR IMMIGRATION STATUS AND GET BACK TO ME.
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    Here in Houston the police just caught a criminal infected w/ TB.

    http://www.alipac.us/ftopict-112402.html

  5. #5
    Senior Member Gogo's Avatar
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    Quote Originally Posted by feduphispanic
    Here in Houston the police just caught a criminal infected w/ TB.

    http://www.alipac.us/ftopict-112402.html
    Disgusting! Thanks for the link fedup.
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  6. #6

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    I was in downtown San Jose last night and we were just talking about *cough* all the foreigners surrounding us and *cough cough* how great it is to be exposed *cough hack* to all these other cultures.

    My friend was telling me he is about to lose his job to an Israeli woman because the company wants to be more cultural and gender-inclusive - even though he just set a national sales record for the company (an electronics store you all know well). He was bitter that he was being excluded because he is a white male, and he had a hard time believing that being a female in science sure has not opened any doors for me. I didn't argue about it - I was too busy noticing the overwhelming number of Indians out at a popular English beer joint. The upscale dance places are even more "multicultural" because that's who can afford to go there.

  7. #7
    Senior Member StokeyBob's Avatar
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    San Jose CA: highest rate of TB in the nation ...why?
    In one word I would guess it would be spitting.

    It's an epidemic here.

    Many times when I see people spitting it makes me salivate. Then I too feel the need to spit. I can't stand the filthy habit so I try and ask them to stop when I see it in areas that we share at break time.

    I've seen it go unabated.

    What happens is one person starts spitting and another sees it and I assume they start salivating. They too start spitting. Before you know it the place that you trying to relax and eat is covered in lunger's and loogies. The wading through them is no picnic. You will see them there for days. If you get any moister in the air they will rehydrate somewhat. Eventually they do dry out. Once they do the wading through them turns them into dust. Dust we all breath and snort. It is no wonder the number of sinus infections that spread.

    I've seen our break area covered to the extent that there is no spot uncovered that is farther away than six inches.

    It freaks me out.

  8. #8
    Senior Member butterbean's Avatar
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    Quote Originally Posted by StokeyBob
    San Jose CA: highest rate of TB in the nation ...why?
    In one word I would guess it would be spitting.

    It's an epidemic here.

    Many times when I see people spitting it makes me salivate. Then I too feel the need to spit. I can't stand the filthy habit so I try and ask them to stop when I see it in areas that we share at break time.

    I've seen it go unabated.

    What happens is one person starts spitting and another sees it and I assume they start salivating. They too start spitting. Before you know it the place that you trying to relax and eat is covered in lunger's and loogies. The wading through them is no picnic. You will see them there for days. If you get any moister in the air they will rehydrate somewhat. Eventually they do dry out. Once they do the wading through them turns them into dust. Dust we all breath and snort. It is no wonder the number of sinus infections that spread.

    I've seen our break area covered to the extent that there is no spot uncovered that is farther away than six inches.

    It freaks me out.
    EWWW! Thats sickening. Have you ever watched someone sneeze? It the lighting is good, you can actually see small tiny dust-like particles flowing outwards in a cone shape that extends for approximately 10 feet. Imagine getting hit or breathing in these tiny particles of SPIT. You are bound to get TB.
    Just think about all the salad bars that are out there. I know they have "window shields" around them, but thats not going to protect the salad when someone sneezes all over the place. Alot of resturants and grocery stores have shut down salad bars for this reason. YUCK!
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  9. #9
    Senior Member Gogo's Avatar
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    I love CSI. I have two friends who are CSI's in L.A. county. Anyway, the one segment they were doing DNA off a shirt to see if the suspect had been with the victim. They explained that just talking to someone unseen particles of saliva leave the mouth and travel a short distance.

    My friends, friend is the consultant for the show. All of the forensics on the show are real. However, for the time line things are much accelerated in time.
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