Reports that show the number of reported cases of tuberculosis, an infectious, potentially fatal disease that primarily affects the lungs, in the United States and in Tennessee is on the decline are welcome. They also are misleading. TB, especially the exotic drug-resistant strains of the malady, remains a major if indirect threat to the health of Americans and a major killer elsewhere around the globe.
The reduction in cases is remarkable. In Tennessee, 202 active cases of TB were reported to the Department of Health in 2009, a decline from the 282 active cases recorded in the previous year. Nationally, 11,540 cases were reported in the United States last year, a drop from the 12,905 TB cases recorded in 2008. Unfortunately, the progress made against the disease in the United States and in several other highly developed nations is not mirrored elsewhere.
Worldwide, TB remains a killer. Indeed, world health officials report that the disease, long known as “consumption,” is the second leading killer of adults around the globe and that TB is the cause of death for nearly two million individuals a year. America’s line of defense against the disease appears generally effective – the decline in cases indicates that – but there is growing and understandable fear that it can be breached. The effort to prevent such an occurrence is on-going, but its effectiveness is unsure.
The main problem is not within U.S. borders, but outside them. While cases here are in decline, they are rising rapidly elsewhere. Worse, an increasing number of cases of TB are resistant to known antibiotic cures. The deadly new variants, which have arisen because patients have not finished their treatment regimes, now threaten to invade countries that are generally free of TB.
The disease is increasingly rampant in many African countries, in parts of Russia and in some places in Asia. Significant increases in TB rates have been reported, as well, in Mexico, the Dominican Republic and Haiti (before the horrific earthquake). The proximity of the latter countries and the relative ease with which individuals move around the globe make the transmission of disease difficult to detect and to contain. That’s a growing problem for the United States, a tourist destination for millions each year and the new home of choice for immigrants from many nations where health care is almost nonexistent.
The lack of information is particularly vexing for public health officials here. While a majority of countries provide reports on the incidence of TB, about 80 don’t track cases at all. That makes detection of TB, and its subsequent treatment, difficult in other nations.
Early detection and treatment remain the most effective way of preventing the spread of TB, an airborne disease. Health departments here, for example, provide free skin tests to those at risk to determine if they have a TB infection that can develop into active disease. If the test is positive, effective treatments are generally available – but that certainty is also at risk.
The system works, but only if those most at risk can be identified in a timely fashion. That’s not always easy given the speed at which people – and the diseases they can carry – can travel from place to place these days.
There’s no ready antidote to the growing global incidence of TB, but additional funding for research, for treatment and detection campaigns and for development of new drugs will help. So will educational programs. The alternative is the possible reversal of the decline in TB cases here and across the United States. That is a prospect that is frightening to contemplate.