Tuberculosis strikes back Infectious killer: Global resurgence could undermine success in U.S.

April 18, 1996

AMERICANS HAVE many health worries, but in recent decades tuberculosis hasn't been among them. That could change, given the resurgence of this highly infectious disease elsewhere. At a time when air travel can quickly transport bacteria, even remote outbreaks can pose a threat.

Two years ago, a Korean woman traveling by air to Honolulu from Baltimore was severely ill with tuberculosis. She was hospitalized soon after landing in Hawaii and later died. Scientists determined that, during the flight, she had infected four passengers sitting nearby. The incident illustrated even countries with good records of controlling tuberculosis can be vulnerable to renewed outbreaks.

Three years ago, the World Health Organization declared a "global TB emergency," but little progress has been made in containing the epidemic. The disease currently infects some 1.9 billion people, one-third of Earth's population; the disease kills 3 million people each year. Because TB can be transmitted through coughing, sneezing or even casual conversation, an untreated person with active TB can infect 10 to 15 people in a year.

If those figures are alarming, there is comfort that most cases of ++ tuberculosis are easily treatable with antibiotics. But partial or inconsistent treatment fosters the development of drug-resistant bacteria. Already, some 50 million people around the world are infected with strains of the disease that resist treatment by one or more of the common anti-TB drugs.

Baltimore can take pride in anti-TB efforts. In 1978, after several years of ranking in the top three U.S. cities for TB rates, the city health department undertook a simple but effective program aimed at patients who were not cooperative in taking their medicine. Tenacious public health nurses tracked down difficult patients and watched them take their daily medicine.

This low-tech approach produced dramatic results. Baltimore has been one of the most successful cities in controlling tuberculosis, and has been virtually free of drug-resistant strains. It needs to continue this vigilance -- and other cities need to follow our example.

Pub Date: 4/18/96

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