AT a time when we have more medical technologies than ever, one communicable disease has touched the lives of an estimated 2 billion people -- one-third the Earth's population. Tuberculosis, once close to eradication in the United States, is a looming health threat nationally and globally.
Friday is World TB Day, an opportunity to raise TB awareness. The good news is that tuberculosis is preventable and treatable. The bad news is that TB has no national boundaries. International TB controls are essential, given that people and disease can travel from one end of the globe to another within 36 hours.
Tuberculosis is an airborne communicable disease. TB infection results from prolonged and close exposure to someone with active TB disease. Persons with TB infection are not contagious or sick. Preventive medication can prevent progression from TB infection to disease.
If, however, preventive medication is not taken, TB disease can develop and individuals can become contagious and sick. Multiple medications administered over six to nine months (sometimes longer) are required to treat TB disease. Failure to take medications appropriately can put whole communities at risk for TB transmission.
Alameda County Public Health Department will hold a joint press conference Friday with the San Francisco Health Department to paint a regional picture of TB control. In Alameda County, despite beefed-up TB reporting and surveillance, the number of TB cases increased from 224 to 242 during calendar year 2000.
TB cases in San Francisco declined last year, but both counties have rates that far exceed the national average. The case rates in Alameda and San Francisco counties are respectively three and four times the national average.
In Alameda County, 71 percent of persons with TB infection are foreign-born. And increasingly the elderly are being impacted: 30 percent of those with TB infection are 65 and older. Although roughly 41 percent of those with TB are Oakland residents, we are seeing tuberculosis increasingly among South County residents.
Fighting TB disease is the top priority, but the reservoir of TB infection remains a vexing problem. It is estimated that 10 percent -- or 144,000 -- Alameda County residents have TB infection. Persons infected with TB need medical evaluation and treatment to prevent the infection from progressing to TB disease.
What steps must we take? We need policies that strengthen TB control and increased funding to fight both TB infection and disease. We also must heighten awareness among all citizens about TB symptoms, transmission and treatment.
Health jurisdictions need more funds to pay for TB medications and services. Nationally, TB funding is flat and international funding levels are too anemic to control TB effectively. Experts say an additional $1 billion is needed annually for international TB control. Congressional representatives from Ohio and Maryland are introducing bills to increase U.S. support for international TB funding. California Congresswoman Nancy Pelosi has secured increased funding for international TB control from the Appropriations Foreign Operations Subcommittee.
LOCALLY, State Senator Don Perata is sponsoring the Omnibus TB Control and Prevention Act of 2001 (SB843). This bill will augment funding for TB infrastructure of local public health departments, and ensure continuity of care for inmates who go in and out of jails where TB can spread quickly.
In the meantime, prevention is the key. TB skin tests and chest X-rays can detect TB infection and disease, and effective drug therapies are available to fight TB. Adequate resources, constant vigilance and political will are the keys to conquering this preventable communicable disease.
Elaine Conley is TB controller and Dr. Robert Benjamin is TB medical director at the Alameda County Public Health Department.
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