TB hits historic low

200-year record tied to city's tuberculosis control effort

March 25, 2009|By Kelly Brewington | Kelly Brewington,kelly.brewington@baltsun.com

Baltimore has recorded the lowest rate of tuberculosis since it began keeping track of infection rates nearly two centuries ago, city officials said Tuesday.

Last year, the city Health Department reported 32 cases of the disease, for a rate of 5 per 100,000 people. That's down from 47 cases in 2007, a rate of 7.4 per 100,000 people.

"Thanks to an aggressive tuberculosis control program and effective engagement of community health care workers, the TB rates have steadily declined," Mayor Sheila Dixon said at a news conference at Johns Hopkins Bayview Medical Center, the site of a tuberculosis hospital in the late 1800s, when "consumption" was a top killer.

More recently, the city struggled with rates of the disease much higher than the state and national incidence. But last year's rate was nearly identical to Maryland's rate of 4.9 per 100,000 people. Nationwide, the rate was 4.2 per 100,000 people.

Officials credit the tuberculosis control program, a 30-year-old effort in which public health workers make house calls to ensure that those infected are taking their medicine.

Baltimore was among the first cities in the nation to try the approach, which is now duplicated around the world, officials said.

"This is an impressive accomplishment," said Dr. Jonathan Zenilman, chief of infectious diseases at Bayview. "Before this program was instituted, Baltimore consistently had among the top-three rates of TB of U.S. cities."

Tuberculosis is a bacterial infection spread through the air by coughing or sneezing. It can be cured with antibiotics, but the regimen is often rigorous and can consist of up to 20 pills a day for as long as a year.

The disease can infect anyone, but drug users, people who work or live in prisons or homeless shelters, people with HIV/AIDS and those with compromised immune systems are most at risk.

The latest declines are significant for a city with high rates of HIV and a large homeless population, said Dr. Joshua M. Sharfstein, Baltimore's health commissioner.

He said the city has continued to fund the home visits, even in times of shrinking federal grants. Federal money to fight tuberculosis decreases as rates decline, Sharfstein said.

In 2005, after an outbreak among the city's homeless, the city hired a tuberculosis educator to raise awareness in shelters about the disease.

The city's program also gives the health commissioner the right to jail infected people who do not take their medication. They remain in jail over the course of their treatment.

While rates are decreasing, the city must continue to work to prevent a future outbreak, Sharfstein said.

"It would be a big mistake to be lulled into a sense of security," he said. "It is going to require a vigilant team to prevent resurgence."

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