With national attention focused on the AIDS epidemic, most people don't think about other communicable diseases posing a serious health risk.
But public health workers in Anne Arundel County think of little else. And one disease that is always on their minds is tuberculosis.
"It's a potentially explosive disease," said Dr. Katherine Farrell, the county's acting health officer. "People think it's a disease of the past, but it's a real risk. At best, we're holding steady here. But we've been hanging on by the skin of our teeth to keep it that way."
Two weeks ago, the World Health Organization declared tuberculosis a global emergency, estimating it will kill 30 million in the next decade unless immediate action is taken. About 9,000 people a day worldwide are dying from tuberculosis, health experts said at a recent international TB conference in London, partly because their symptoms are ignored or they do not get enough medicine.
Left untreated, TB has a 50 percent fatality rate. When treated with the appropriate medicines, the fatality rate drops to 10 percent, health officials said.
Although some areas of the country, and even neighboring jurisdictions, have experienced increases in TB cases over the past six or seven years, Anne Arundel's numbers have remained steady.
But that, in itself, concerns health officials in the county because before the mid-1980s, TB numbers had been dropping every year.
For the past two years, there have been about 20 new cases of active tuberculosis in the county. If the numbers had continued to decline as they had for decades, health officials estimated there would have been only 12 to 15 new cases each year.
When the health department verifies a new case, an aggressive treatment regimen begins that usually takes six months to a year, and can last even longer. The treatment, referred to as "directly observed therapy," requires a public health nurse to closely monitor all patients, making sure they take the required six to 20
"We literally watch the pill go down their throat," said Dr. Linda Joe, the county's program manager for communicable diseases.
After a couple of weeks, the patient will probably feel better and is no longer contagious, but treatment must continue, she said, or the person will relapse and likely develop a different strain of TB, which is even harder to treat.
Each new case of TB poses a serious risk, health workers said, because TB is an airborne disease that can be spread without intimate contact. When an infected person coughs, TB germs can linger in the air for up to four hours.
"With AIDS, we check for sexual contact and sharing needles," said Dr. Joe, explaining how health workers trace others who may have been infected. "But with tuberculosis, it goes far beyond that."
With each new TB case, nurses interview patients to determine everyone the person has come in contact with on more than a limited basis. Immediate family members, co-workers and friends are then contacted and screened.
If no one else turns up as an active case, the screening generally stops. But if even a couple of other people test as potentially infected, the screening continues, with health workers contacting others who may have been infected.
"Each case requires intensive management and follow-up," said Dr. Farrell.
Many of the new cases are in individuals who test positive for HIV, the virus that causes acquired immune deficiency syndrome. HIV-positive patients are unable to fight TB naturally, said Dr. Joe, whereas in the general population, only 7 percent or 8 percent of the people exposed to the virus will actually come down with it.
Health officials said the resurgence of TB cases coincides with the spread of AIDS nationally. But the spread of the disease is in no way limited to HIV-positive people.
Primary symptoms are a persistent cough lasting for weeks and a low-grade fever, which comes on in the evening. Some people also experience night sweats, lack of energy and minor weight loss.
For further information about TB, call the health department at 222-7256.