Thread: Virulent TB

Virulent TB only 'airplane ride away'
Resistance to drugs is a growing problem

Lindsey Collom
The Arizona Republic
Oct. 1, 2006 12:00 AM

State health officials say tuberculosis is under control in Arizona despite growing national concern over imported drug-resistant strains of a disease that hasn't flourished in the United States since the mid-1900s.

But authorities are still on the lookout for especially virulent strains that could come from Mexico or other countries.

"It's just an airplane ride away," said Dr. Karen Lewis, tuberculosis-control officer for the Arizona Department of Health Services. advertisement




The majority of drug-resistant infections are brought to the U.S. by legal visitors, many of them unaware that they carry the deadliest strains. Lewis said those strains develop when patients interrupt their months-long treatments, giving the still lurking infection a chance to mutate.

In 2005, the most important risk factor associated with tuberculosis in Arizona and nationwide was birth outside the U.S., according to the state's Tuberculosis Surveillance Report, released last week.

Local and national health experts say a recent tuberculosis outbreak in other countries, such as South Africa, where 50 people recently died of an "extensively drug-resistant" strain, underscores the need for testing.



The "extensively drug-resistant" tuberculosis has been found in limited numbers in the U.S, with 74 reported cases since 1993.

The strain is nearly impossible to cure because it is immune to the best first- and second-line tuberculosis drugs.

It's also as easily transmitted as the simple strain.

Nationwide, there has been a spike in milder but lethal "multidrug-resistant" tuberculosis, which responds to more treatments but can cost up to $250,000 and take several years to cure.



About 130 people in the U.S. were diagnosed with multidrug-resistant tuberculosis in 2004, up 13 percent from 2003. More than 40 cases in Arizona were found to be resistant to one or more forms of anti-tuberculosis medication, according to the 2005 report.

That year, Arizona reported 281 active tuberculosis infections. A total of 172 infected people were foreign-born, 68 percent from Mexico, where the tuberculosis incidence rate is 10 times higher than in Arizona.
The report documented a 3 percent increase in tuberculosis in Arizona over the previous year. But officials say there is no cause for alarm: the state has seen a stable number of infections, ranging from 254 to 296 cases, in the past 10 years.

Also in that time, a population surge has decreased tuberculosis rates in Arizona from 6.1 cases per 100,000 people in 1996 to 4.6 in 2005.

Lewis said it's not that easy to catch the disease: only 10 to 30 percent of those living with an infected person are likely to become ill. Yet the risk of being infected with the disease is still very real for first responders.

"We, as caregivers, run the greatest risk," said Chris Ketterer, a Phoenix Fire Department battalion chief. "I would say there's more out there than we're aware of. A person might not look ill because they're in the early stages of the illness, but they might be extremely infectious."
Firefighters and paramedics wear gloves, eye protection and masks when dealing with all patients. They are also regularly tested for tuberculosis and other infectious diseases.

Similarly, the Arizona Department of Health Services' strategy for controlling the incidence rate is to test people who are highly susceptible: non-natives, children with foreign-born parents, people with weak immune systems, those with HIV, the homeless and inmates at correctional facilities.

"The good news is it's treatable, but you need to diagnose it early," Lewis said.

http://www.azcentral.com/arizonarepubli ... s1001.html

Firefighters and paramedics wear gloves, eye protection and masks when dealing with all patients. They are also regularly tested for tuberculosis and other infectious diseases.

Restaurants should take a page from this book and start to voluntarily start test their employees since it no longer required by law. Or, the law needs to be reinstated.