Printer Friendly

Tuberculosis makes insidious comeback in U.S. communities.

Tuberculosis, the scourge thought to be nearly eradicated in the United States, is making a comeback.

Once the nation's leading cause of death, TB began to wane in the mid-20th century due to improvements in diet, hygiene and housing conditions and the development of effective antibiotics that allowed patients to be treated in the community rather that isolated in sanitariums.

The number of reported cases declined yearly beginning in 1953 (when the federal government first collected such statistics).

That is, until 1985. Each year since, the number of occurrences has climbed steadily upward and the disease is now rampant in major cities, particularly among homeless, substance-abusing and immigrant populations.

This upsurge has been compounded by the emergence of a new strain that resists conventional treatment methods and the spread of the Acquired Immune Deficiency Syndrome.

Officials are now looking at reopening long-shuttered residential treatment facilities, resuming mass testing programs and rewriting quarantine laws.

TB is spread through the air in tiny droplets expelled when a person with an active case coughs or sneezes. The bacteria is inhaled by others and usually lodges in the lungs, where it can multiply and cause permanently g lesions.

TB can invade or spread to other organs. Left untreated, it can be fatal.

An opportunistic menace, TB can lie dormant in the body for decades, progressing to the active stage when resistance is low.

The recent resurgence can be attributed to a number of factors, including an influx of immigrants from Third World countries where TB is endemic, increased incarceration rates and economic conditions that have forced many Americans into overcrowded housing and poorly-ventilated homeless shelters where the disease thrives.

An outbreak in Richmond, Calif. two years ago was traced to the city's crack houses, where rooms were tightly sealed to prevent detection of drug abuse by neighbors and police.

"Somebody once said long ago that TB is a social problem with medical implications. That's still true--maybe even more so today," said Hazel Swann chief of TB control for the District of Columbia, which in January began a screening campaign in 43 shelters in January, the nation's first organized effort to combat TB among the homeless.

When the upsurge began, many local health departments had ceased aggressive TB monitoring and no longer had sufficient personnel to track carriers and their contacts. Houston, for example, with more than a million and a half residents, has only four such employees.

Local outreach workers, at risk of contracting the disease themselves, now comb rooming houses, alleys and parks to deliver medication, remind sufferers of doctor's appointments and administer diagnostic skin tests.

However, the task of getting patients to treatment is a difficult one.

The afflicted are disproportionately poor, thus many fail to seek treatment because they lack health insurance or anticipate being turned away from homeless shelters if their condition becomes known. Illegal aliens fear being reported to immigration authorities.

And there are cultural barriers involved in treating immigrants accustomed to relying on traditional folk remedies who must be educated about American-style health care.

A major problem is that many patients fail to complete the lengthy treatment regimen.

Since the medication relieves symptoms within weeks, health workers have difficulty convincing patients to continue to take pills which cause side effects such as hot flashes and stomach pains.

When patients discontinue medication, the strongest bacteria are left to flourish and mutate into the new Multi-Drug Resistant strains. They must then be treated with costlier, less effective drugs which have a cure rate of only 55 to 60 percent.

TB is a costly, labor intensive proposition for local health agencies.

Indianapolis' local health department recently began providing medication to all area patients to ensure treatment, causing spending to jump.

New York, home to 15 percent of the nation's afflicted, and where MDR TB is most prevalent, doubled the size of its TB control unit staff last November. The city's anti-TB strategy includes rewarding patients who keep clinic appointments with fast food vouchers and subway tokens.

Because of a lawsuit filed by a homeless advocate, the New York state supreme court recently ordered the city to offer better shelter conditions to homeless AIDS sufferers.

New York does stand to benefit from the first major U.S. study of drug treatment strategies for AIDS patients with TB. Last month, the federal government announced that up to 650 HIV-infected TB sufferers, a significant portion in New York, will be enrolled in clinical trials of a new drug.

Long Beach, Calif., with a large, high-risk immigrant and HIV- positive population, has already taken such an approach. The city declared a local emergency in 1989, when the rate of new TB cases was double that of the previous year, and last summer, public health officials formed a coalition with leaders of its gay, homeless, Latino, black and Asian communities to formulate a TB awareness plan. Public health can't act alone, so we're adopting the team approach," said Preventive Health Services Manager Ruth Bundy.
COPYRIGHT 1993 National League of Cities
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Turner, Laura
Publication:Nation's Cities Weekly
Date:May 3, 1993
Previous Article:Cities address kids' health care with innovative programs.
Next Article:Charlotte opens the door to the new global economy.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters