Feared disease makes a comeback

USA Today (Society for the Advancement of Education), Feb, 1995

Tuberculosis, once the nation's leading killer among diseases, has been around and making its mark on civilization for centuries. The development of antibiotics, as well as a better understanding of preventive measures, finally provided the means for health care professionals to control the disease. In the early 1980s, TB was thought to have been nearly eradicated. In 1986, however, cases of TB in the U.S. increased for the first time since 1953. Since then, the number has risen every year. More recently, drug-resistant strains have emerged. In the U.S., approximately 10,000,000 people currently are infected. Worldwide, there are an estimated 8,000,000 new cases of TB each year and 3,000,000 deaths.

Because TB is spread through airborne bacteria, anyone can become infected. Individuals who live in close quarters or have vulnerable immune systems are at greater risk because contagion usually requires close contact with an infected person's breathing space over several hours.

The dominant reason for tuberculosis' comeback is the increase in the conditions that foster it, including growing numbers of drug abusers, AIDS patients with vulnerable systems too weak to ward off the disease, homeless people in crowded shelters, and poor people living in cramped quarters without health care. Because the sanitariums, hospital wards, and other facilities to care for those with TB have been closed, there was nowhere to treat the new cases. Health care professionals have had to start from scratch to battle a disease they thought was almost extinct.

Meanwhile, poor patient compliance with treatment has promoted the growth of dangerous drug-resistant strains. These develop when patients do not complete the course of treatment, fail to take their medicine, or don't use their medication properly. Within a large population of cells with the Mycobacterium tuberculosis infection, there exists a small number of cells that are resistant to the prescribed or administered drug. Proper medication will kill these cells; insufficient medication allows for these resistant cells to multiply to become the predominant cell type.

Patients with drug-resistant TB pass it on directly to those they infect. To avoid developing drug resistance, patients with TB must complete their entire treatment. However, because traditional TB treatment is lengthy and complex --as many as six or seven different drug treatments, all of which carry different regimens--people are less likely to complete it.

In May, 1994, the Centers for Disease Control and Prevention and the American Thoracic Society issued a joint statement regarding the treatment of tuberculosis. It urged that consideration be given to treating all patients with directly observed therapy--a process whereby a health care professional monitors them to ensure that they take the medication as prescribed.