To control and beyond: moving towards eliminating the global tuberculosis threat (World 1/3 have TB)

Journal of Epidemiology and Community Health ^ | 2004 | Timothy F Brewer and S Jody Heymann

[neverdem]

Abstract

For 10 years the World Health Organisation has had a single answer to the deadly threat of tuberculosis (TB)—provide treatment to smear positive patients and watch them take it. In contrast with confident statements about how global TB would be brought under control when directly observed therapy, short course (DOTS) was introduced, TB continues to rise worldwide. The introduction of selected multiple drug resistant TB treatment programmes, "DOTS-Plus", although important, also focuses on therapy for active TB. HIV endemic countries in particular have experienced tremendous increases in TB despite having DOTS programmes. A critical review of recent epidemiological data and computer models shows that the present international strategy of concentrating on providing treatment for smear positive TB, DOTS and DOTS-Plus, is likely to have only a modest impact on population based TB control. Effective global TB control will require strategies that go beyond relying on treatment of people with active disease.

Abbreviations: TB, tuberculosis; DOTS, directly observed therapy, short course

Keywords: tuberculosis; public policy; control programmes

In 1993, the World Health Organisation declared tuberculosis (TB) a global health emergency. One third of the world’s population was believed to be infected with TB, and 7.5 million new TB cases and 2.5 million TB deaths occurred each year. One in four preventable adult deaths worldwide was attributable to TB.

[neverdem]

I hope the open borders crowd doesn't get upset.

Journal of Epidemiology and Community Health 2004;58:822-825

[Gondring]

It was in 1993 that my doctor was ranting on and on about the TB problem and how he was seeing the rate of cases increasing like mad in his practice from the immigrant influx.

[WilliamofCarmichael]

Tuberculosis gaining ground in the United States along with record legal and illegal immigration -- there's a correlation and I don't like it.

Let the open border crowd do their wont; i.e., name calling. Call me a bigot.. please!

That silly tactic is outworn from overuse by liberals last century. It's no longer effective to hide an admission that one cannot refute facts.

[neverdem]

Quarantine sought for harsh TB strain (18)

WETTBEWERBSSTÄRKUNGSGESETZ

Endurance sports may harm the heart: study (11)

FReepmail me if you want on or off my health and science ping list.

[jammer]

I am with you--and the authors--all the way on that. But 1/3 of the world's population? Almost 2 billion people? I wonder if they don't hurt the case by, perhaps (a word I stress), overstating the problem. That just doesn't seem right and makes truly worried people seem like Chicken Littles. I dunno'. But it IS GWB's fault.

[neverdem]

But 1/3 of the world's population?

I didn't make it up. That's why I posted the abstract, statement and included a link to the original paper which was cited as the source. There's an asymptomatic type of TB called latent for those who were infected but still have competent immune systems, IIRC. They can have positive skin tests to PPD, Purified Protein Derivative from TB, or from having been given the BCG vaccine, but their chest X-Rays are normal, and they don't have symptoms. It's too late for me to read that paper now.

[jammer]

I wasn't accusing you of making it up--I was questioning the WHO.

[happygrl]

Drug resistent TB strains have been incubated in Russian prisons and in areas of the Third World where TB treatment previously did not include daily delivery of medication and observation as it was ingested.

Schools in California have also become centers of infection.

There is a rudimentary vaccine called BCG used in Mexico and the Third World, but as the article indicates, existing vaccines are not effective.

[happygrl]

There's an asymptomatic type of TB called latent for those who were infected but still have competent immune systems, IIRC.

My friend's son, born and raised in California, was identified as having latent TB over 10 years ago as a preschooler. He received treatment, but will always test positive for the TB baccillus.

She was a school teacher, and often took her son to her school early before class started, then on to daycare.

I have no doubt that there are many undiagnosed American children with latent TB, especilly if they are exposed after starting Kindergarden when a TB screening is required.

[RedWhitetAndBlue]

I posted this on another threat, but I copied it here to help provide some clarification on the "1/3" statistic:

This is true, and few people know it. It's important to draw a distinction here, however. This doesn't mean that 1/3 of the population is sick with TB disease, which is infectious and can be passed to others. What it means is that 1/3 of the world's population is infected with the TB bacillus, which doesn't involve symptoms and can't be passed to others. Roughly 10% of these will develop active disease at some point in their lives, at which point they can then pass the germ to others, each of whom on average would have a 10% lifetime chance of developing TB disease, and so on.

The depletion of the immune system that follows HIV infection, however, increases the chances of developing TB disease to 10% EACH YEAR after TB infection. This is why Africa and Southeast Asia (areas hit hardest by HIV) have seen skyrocketing rates of TB since the 1980s. The two diseases work in tandem--like gasoline and a match.

[jammer]

Yes. My point was poorly made that the "active" distinction might have been made in the article. In fact, I have positive PPDs and have to take a chest xray every year for the hospital records. I know the difference, and thanks.