Monday, March 23, 2009 - 7:47am
Important Reminder of Local Relevance
Public Health Madison & Dane County
Madison WI - March 24, 2009 - With the occasional exception of a headline about a TB-infected airline passenger, we normally don't have much occasion to think about tuberculosis. Some people even think of it as a disease of the 19th and 20th centuries that has little to do with current challenges to our health.
So why do agencies like the Centers for Disease Control still consider it important enough to reserve March 24th as World TB Day? Aside from the fact that on this date in 1882 Dr. Robert Koch announced his discovery of M. tuberculosis, the bacteria that cause TB, there are a few more astonishing facts about this disease that deserve our attention. The most significant is that TB is the world's most prevalent infectious disease killer, more than influenza, more than AIDS. TB kills more than 2 million people annually. It is estimated that one-third of all human beings are infected.
The recent increase of "multi-drug-resistant"(MDR-TB) strains of bacteria has caused the World Health Organization to declare tuberculosis a global emergency. Approximately one in five infected individuals in some parts of the world carry the MDR-TB strain. Although the United States is relatively better off, the prevalence of international travel requires constant vigilance and preparedness for an effective and forceful response.
The disease itself usually attacks the lungs but can also attack other parts of the body such as the kidney, spine, and brain. Without proper treatment, TB can be fatal. In fact it used to be the leading cause of death in the United States. The Northport Drive office of Dane County Department of Human Services was once a TB sanitarium, an architectural reminder of how widespread this disease used to be right in this area.
In Dane County, we have been particularly fortunate. In 2007, we had 4 reported cases of TB (2 of which were MDR) compared to recent high of 15 cases. Although MDR-TB can be cured, it requires, at a minimum, intensive medical and nursing supervision over two years of daily treatment with multiple drugs, taken orally and by injection. The cost is hundreds of thousands of dollars per case so even a small case load represents a challenge to our public health infrastructure, taking approximately three times the staffing resources as a non MDR case.
Since TB represents a threat to public health, our local public health department (Public Health Madison and Dane County) is obligated to track every active TB case in the county as well as to identify those who may have been in contact with the patient. This means assuring that anyone with a positive TB skin test receives proper medical evaluation, follow up testing and treatment as appropriate. Our public health nurses (PHNs) initially visit active TB client every day, then twice a week to assure that the required medications are taken throughout the treatment period. While costly, these visits are the most cost effective means to prevent the development of drug resistant strains of TB. PHNs also provide education to the patient and family as well as assisting the patient to access the range of help required. This is no small matter since anyone with active TB disease needs at least 2 weeks of isolation, which usually means that they cannot work. Many patients live on the brink of poverty and need both medical and other financial and housing support until they are no longer infectious.
According to Dr. Thomas L. Schlenker, director of Public Health Madison & Dane County, "dealing with TB represents a huge investment of time, effort and resources by the health care system, public health and, sometimes, judicial system but it is, nevertheless, money well spent. The alternative is the widespread transmission of a potentially lethal disease, something that no society can ever afford."
For a list of frequently asked questions and answers about TB, please see the fact sheet produced by the Centers for Disease Control at http://www.cdc.gov/tb/faqs/default.htm.
- Jeff Golden, (608) 243-0302