Coalition Urges Diligence in Combating Global, US Tuberculosis; March 24 is World TB Day: An Opportunity to Address TB Emergency

3/24/2003

From: John Seggerson, 770-455-0801, for the US National Coalition for the Elimination of Tuberculosis

WASHINGTON, March 24 -- The U.S. National Coalition for the Elimination of Tuberculosis (NCET) said today it strongly supports World TB Day, held on March 24 each year, as an occasion for people around the world to recognize the international health threat posed by tuberculosis (TB). It also is a day to recognize the collaborative efforts of all countries involved in fighting TB. It is an opportunity to spread the word that TB can be cured, controlled, and, with diligent efforts and sufficient resources, eventually eliminated.

Globally there are almost 8 million new TB cases annually with over 2 million deaths each year. Over 80 percent of the world's TB cases occur in just 22 countries; this concentration makes it feasible to target limited resources. Accordingly, NCET supports the efforts of the World Health Organization, the Centers for Disease Control and Prevention (CDC), the American Lung Association and other partners that have responded to the global TB emergency.

Here in the United States, NCET is pleased to note a 5.7 percent decrease in tuberculosis cases for 2002, as reported last week by the CDC. This decline is a stark difference from the late 1980s and early 1990s when there was a national resurgence of tuberculosis accompanied by outbreaks of deadly drug-resistant TB. A major cause for the TB resurgence was a deterioration of TB control programs in many parts of the nation. NCET, through coalition and partner efforts, secured the necessary support that reestablished control of the disease in the mid-1990s.

Coalition members are concerned that the national interest in TB has begun to wane in recent years. There is legitimate concern that public awareness of the problem may be diminishing and that communities may again dismantle their control efforts because of the fading concern and growing budget problems faced by many state and local governments. NCET believes we must never again allow a resurgence of TB in the United States. This time, we must eliminate the disease, not the TB control programs.

Tuberculosis in the United States can be prevented. In 2002, for the first time, over half of U.S. TB cases occurred in foreign-born individuals. Still, 49 percent of TB cases in the United States are "homegrown," occurring in persons born here. The disease particularly affects the disenfranchised, minorities, homeless, prisoners, persons at risk for HIV/AIDS, health care workers, and inner city and rural poor. In 2001, 30 percent of all TB cases in the United States occurred among black, non-Hispanic individuals, 25 percent of the cases occurred among Hispanics, 22 percent among Asian/Pacific Islanders, 21 percent among white, non-Hispanics, and about 1 percent among American Indian/Alaskan Natives. TB is also a particular problem for the U.S. South. The majority of cases in the Southeastern states occur in non-Hispanic blacks. The annual case rates in most of these states are higher than the national average; 85 percent of the TB cases in these Southeastern states occur in persons born in the United States.

The disease is not gone. The seeds of tuberculosis do germinate and appear in our communities. This happens every day. Outbreaks of TB infection and disease still occur all too often in communities throughout the nation, even in affluent, low-incidence communities. NCET believes this should not happen.

What does this mean? It means that:

-- Physicians must suspect TB in persons with symptoms.

-- Laboratories must be available to identify TB in those persons.

-- Quality medical care and treatment must be available for individuals with active TB disease and latent TB infection.

-- Health department staff must be available to work with the medical community to make sure that everyone being treated for TB actually takes their medicine. If TB patients do not take their medicine, they can and will develop and transmit drug resistant TB. Therefore, directly observed therapy for TB patients should be considered as the "Standard of Care."

-- Health departments must improve the speed and accuracy of finding persons exposed to TB.

-- Health departments must identify their unique high-risk groups and work to eliminate the disease by providing preventive treatment to those at highest risk.

-- Health care facilities must maintain infection control to prevent the spread of TB to patients, visitors and medical care personnel within health care facilities.

-- TB research efforts now under way in the United States must continue to identify better drugs and tools to treat, prevent and eventually eliminate TB.

To do all of this, our national, state and local governments must not again abandon tuberculosis prevention, control and research efforts.