WASHINGTON – The worst forms of a drug-resistant killer tuberculosis bug, rapidly spreading throughout the world, have been gaining ground in the United States along with record legal and illegal immigration levels, alarming public-health officials over a disease once thought vanquished.
Although the number of confirmed drug-resistant TB cases in the U.S. is relatively small – still measured in the dozens – health officials say visitors from other countries are bringing in the deadliest mutations.
The only visitors to the U.S. who are screened for tuberculosis and other medical conditions are immigrants who enter the country legally. There is no easy way to screen millions of tourists and illegal migrant workers.
Worldwide, TB kills 2 million people a year, mostly in Africa and southeast Asia, but recently the European Union issued a warning that the threat there is considerable.
The drug-resistant TB recently killed more than 50 people in South Africa. It has been found in limited numbers in the U.S. – 74 reported cases since 1993. The strain is nearly impossible to cure because it is immune to the best first- and second-line TB drugs. It is as easily transmitted through the air as the old TB.
There is another form of TB concerning U.S. health officials. It is called “multi-drug resistant.” It responds to more treatments but can cost up to $250,000 and take two years to cure. This is the strain increasingly common throughout the world – rising more than 50 percent from about 273,000 in 2000 to 425,000 in 2004, according to a study published in August in the Journal of Infectious Diseases.
In the U.S., 128 people were found to have it in 2004, a 13 percent increase from the previous year.
The states with the highest numbers of multi-drug resistant cases in the last decade were New York, California, Texas and Florida, according to the CDC – states with the highest populations of new immigrants.
Tuberculosis is a bacterial infection that primarily affects the lungs. TB is more common in urban areas. It is highly contagious and caused by bacteria. Many people infected with TB have no symptoms because it is dormant. Once it becomes active it may cause permanent damage to the lungs and other organs. TB is spread through the air by inhalation.
Over the last 30 days, TB has been discovered in dozens of states:
- Last month, six employees who work inside Detroit’s AT&T building tested positive. Investigations into the outbreak are ongoing.
- In Oklahoma City, hundreds of patients and hospital workers may have been exposed to tuberculosis by a health-care worker, and at least 10 people caught it. A letter sent to 1,650 patients and 350 workers at Integris Southwest Medical Center in Oklahoma City warned of their potential exposure and urged them to get skin tests to determine whether they were infected.
- In Alabama, 22 LeFlore Preparatory Academy students and faculty members tested positive for tuberculosis infection and are undergoing further examination to determine if they have an active case of the disease, Mobile County Health Department officials said last Monday. The people who tested positive were among 909 who elected to be screened after a student was diagnosed with the disease.
- In Florida, public health and school officials said they had confirmed a case of tuberculosis at a Manatee County middle school. Seven months ago, it was announced that a school district employee whose job required visits to several campuses had active TB.
- In Cincinnati, a student and teacher visiting a high school became infected.
- In Connecticut, health officials are trying to figure out whether a University of Hartford student has tuberculosis.
- In South Texas, a second group of students and staff at McAllen’s Zavala Elementary School were forced to undergo skin tests today after a student was discovered carrying the contagious airborne disease.
- In Pennsylvania, hundreds of Upper Moreland High School students had to be tested after the Montgomery County Health Department notified parents in the district that a male student had become infected over the summer.
- In Mississippi, more than 10 percent of the 102 Meridian firefighters have tested positive for the tuberculosis antibody, but state health officials say there is little cause for concern.
- In South Georgia, Mitchell County health officials are investigating a case of tuberculosis at a major chicken processing plant.
- In California, more than 6,000 inmates at California State Prison-Solano are being tested for tuberculosis after two inmates were discovered with the disease.
- In Wisconsin, nearly 100 students and staff may have come into contact with a West Allis day care employee infected with tuberculosis, health officials report. The employee, who had active TB, is being treated and is no longer at the center.
Canada has also been hit with the disease – especially the Indian populations, but also increasingly among new immigrants from nations where the disease is endemic.
“With the shrinking of the global community with the transient nature of the world’s population, TB has the potential to come to Canada time and time and time again,” says Bob Dickson, a Calgary medical doctor and partner with RESULTS Canada, an NGO dedicated to fighting poverty and disease in the third world.
The World Health Organization reports that one-third of the globe’s population is infected with the airborne bacteria that causes the disease.
The general symptoms of the disease include feelings of sickness or weakness, weight loss, fever and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected.
It is generally spread when someone with the infection coughs, sneezes or talks to another person, but prolonged contact is usually needed. People most at risk of developing tuberculosis include children and older people, smokers, those living in overcrowded conditions, those who have a poor diet, the homeless and those who have a weakened immune system.
Antibiotics are used to treat the infection, but they must be taken for at least six months to be effective.
The occurrence of drug-resistant strains of tuberculosis is also on the increase in Eastern Europe.
Health officials in Finland are particularly concerned because the multi-drug resistant form of tuberculosis has already found its way to Estonia and St. Petersburg.
About 450,000 people get infected with tuberculosis each year in the Europe region, including Eastern Europe and Central Asia, according to Pierpaolo de Colombani, a tuberculosis control medical officer for the World Health Organization.
Nearly 70,000 of these contract strains of the easily-spread respiratory ailment that resist the two main tuberculosis drugs, raising the likelihood that the disease could lead to epidemics in Western Europe on the scale of that seen in the 1940s.
“The drug resistance that we are seeing now is without doubt the most alarming tuberculosis situation on the continent since World War Two,” said Markku Niskala, head of the International Federation of Red Cross and Red Crescent Societies.
“Our message to EU leaders is: wake up, do not delay, do not let this problem get further out of hand,” Niskala said.