Thread: Washington saw rise in number of TB cases

Originally published March 24, 2010 at 8:29 PM | Page modified March 24, 2010 at 9:14 PM

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Washington saw rise in number of TB cases
The number of overall TB cases in 2009 rose 12 percent in Washington, one of the few states that saw an increase. Nationally, the number of TB cases has been dropping for 17 years.

By Kristi Heim



It's a sign of the air we share — drug-resistant tuberculosis has reached a record high in the world, and cases are showing up in Washington state.

In fact, the number of overall TB cases in 2009 rose 12 percent in Washington, one of the few states that saw an increase. Nationally, the number of TB cases has been dropping for 17 years.

There were 256 cases of tuberculosis reported in Washington last year, including two cases of multidrug-resistant TB (MDR-TB) and three deaths. More than half of the cases were in King County.

Globally, the contagious airborne disease infects about a third of the world's population and kills nearly 2 million people a year.

In some areas, one in four people with tuberculosis has a form of the disease that no longer responds to standard drugs, according to a new report by the World Health Organization. WHO estimated that 440,000 people had multidrug-resistant TB in 2008 and a third of them died.

It's hard to pinpoint exactly what's behind the increase in Washington, but the state does have more immigrants and refugees from places where the burden of TB is high, mainly Southeast Asia and Africa, said Kim Field, a registered nurse who manages TB services at the state Department of Health and has 17 years of experience in TB control. More than 75 percent of the state's cases last year were in foreign-born populations. Thirty-four patients were from the Philippines and 25 from Mexico.

But that doesn't fully explain it. Minnesota has a similar refugee and immigrant population and yet saw a drop in TB cases. Delayed diagnosis also may play a role, Field said, since people with TB may unknowingly spread the infection to others.

In a case late last year, a man with symptoms of TB arrived in a hospital in Eastern Washington. The emergency-room doctor suspected TB and called the county public-health department. He couldn't reach anyone because employees were on furlough, Field said.

"You're left with this ER doctor and myself on the phone trying to fight TB," she said.

The doctor ran tests and collected information, but the man left before he could be diagnosed, saying he was headed to California. The Washington authorities sent a report on the possible TB case to California, and a month later the man turned up there, tested positive for TB and finally got on treatment.

The two cases of multidrug-resistant TB in Washington are currently being treated and doing well, Field said. But treatment is expensive — the total cost per patient is nearly $100,000, she said.

The disease disproportionately affects the poor and homeless, and many patients don't have insurance, Field said. Even if they do, insurance generally doesn't cover second-line TB treatment, which often involves intravenous drugs and longer hospital stays or visits by a case manager.

Prompt diagnosis and treatment with proper antibiotics is key. If a TB patient starts treatment but doesn't finish it, that can increase drug resistance.

With global travel and migration, "TB anywhere is TB everywhere," said Peter Small, senior program officer for TB at the Bill & Melinda Gates Foundation. He said the disease is at a critical tipping point, where new tools to diagnose and fight it are being developed, but co-infection with HIV is fueling an epidemic, and drug-resistant TB poses an unprecedented global threat.

There are six TB vaccines now in the human-trial phase, nine drug molecules being tested for potential new treatments and at least a dozen new diagnostic tests, he said.

"For Seattle, we are making huge progress in making better tools to fight TB," Small said.

Seattle-based research institutes are major players in developing new tools to diagnose and fight TB. The Gates Foundation has donated close to $900 million to fund those and other TB efforts in the last decade.

One Seattle research program is a TB-control project in China that includes new ways to monitor treatment using cellphones.

"We've made tremendous progress using a simple approach," Small said. "Now we have these critical new challenges but innovation coming on line that can put TB control into the next gear."

Kristi Heim: kheim@seattletimes.com



http://seattletimes.nwsource.com/html/l ... _tb25.html

I think we have all sorts of viruses---great and small----waltzing in here. Why would a cold or flu virus from somewhere as far away as Peru or Chile be the exact same virus found in North America? They may even look the same under a microscope but have they ever heard about mutations? I know a lot of people that have been extraordinarily sick over the last few years.