Infectious Diseases Make a Comeback

DANIEL S. GREENBERG

September 15, 1992|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- "Certain infections that are essentially untreatable have begun to occur as epidemics both in the developing world and in institutional settings in the United States.''

That disturbing report is from a recent article in the distinguished journal Science by a researcher from the U.S. Centers for Disease Control, Mitchell L. Cohen.

Reflecting a widely held view in the health community, he calls for a decisive response in prevention, treatment and development of new drugs.

Another warning of wholesale doom unless government acts at once?

From nuclear proliferation to errant asteroids, public dialogue is so heavily laced with fearsome scenarios that inattention from sheer overload is inevitable if not forgivable. That must not be the fate of the worldwide concerns that health professionals have begun to express about the resurgence of diseases long thought to have been banished or brought under control.

The alarm they're sounding involves many of the disabling or lethal scourges rampant throughout the world before the postwar health revolution produced by antibiotics, vaccines, sanitation and other public-health measures.

With the elimination of smallpox and polio and effective treatments for tuberculosis and other infectious diseases, the health establishment declared victory against many of the most feared microbial afflictions.

As noted in Science, the surgeon general announced in 1969 that the time had come to ''close the book on infectious diseases.'' Medical-research money and scientists were redeployed to cancer and heart disease, the newly favored fronts in the war on disease.

The dismal news of our time is that several of the most dangerous infectious diseases, particularly tuberculosis, have made a savage comeback, while the roll of deadly maladies has been crowned by AIDS, still incurable after a decade of intensive research. Especially worrisome is the increasing dual infection of AIDS with highly contagious TB.

In the case of TB, as with several other diseases, the resurgence is complicated by increased resistance to previously effective drugs. TB is the world's leading cause of death from infectious disease, with 8 million new cases reported annually, and 2.9 million deaths, according to another article in Science, by Barry R. Bloom, of Albert Einstein College of Medicine, and Christopher J. L. Murray, of Harvard School of Public Health.

Though the figures for the U.S. remain relatively low -- 26,283 cases reported last year -- there is no reason for complacency, particularly since TB cases had generally declined in the United States from 1953 until the mid-1980s. Since then they've risen 18 percent.

Last year, one-third of all cases tested in New York City were resistant to one or more TB drugs, while all 50 states reported the presence of the disease and resistance to drugs.

Drug resistance and increases in the number of cases have also been reported for other infectious diseases, including streptococcal infections, which, in an extremely lethal form, killed Jim Henson, the renowned TV puppeteer.

The return of tuberculosis and other infectious diseases is often attributed to recent waves of immigration, but researchers report that newcomers to this country account for only a minor share of the increases. Homelessness and drugs are major culprits, too.

Meanwhile, budget cuts have riddled programs for tracking TB cases and assuring that patients take their medicine -- historically, extremely effective measures for preventing spread of the disease.

Noting that the TB increase has so far been concentrated in homeless shelters and prisons, and among intravenous drug users, Drs. Bloom and Murray write in their article, ''Even more worrisome is the possibility that active transmission has been spilling into the general population.''

The suffering and high medical costs of many of the new cases, they state, could have been avoided by relatively inexpensive treatment programs. They also note that, because of complacency in the U.S. about control of infectious diseases, ''a generation of expertise has been lost.''

They add a cogent warning: ''In the world of infectious diseases, there is nothing from which we are remote and no one from whom we are disconnected.''

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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