More Drug-Resistant TB Seen in U.S.
Pastor Dale Morgan
Sep 22, 8:46 AM EDT
*More Drug-Resistant TB Seen in U.S.*
By JORDAN ROBERTSON
Associated Press Writer
SAN FRANCISCO (AP) -- The worst forms of the killer tuberculosis bug
have been gaining ground in the United States, alarming public health
officials over imported drug-resistant strains of a disease that is
mostly under control in this country.
Although the number of drug-resistant TB cases in the U.S. is small
compared to developing nations, health officials here warn that visitors
from other countries who are unaware of their infections are bringing
over the deadliest mutations.
Often those with drug-resistant strains stop taking their medicine when
they feel better but aren't cured.
That's what happened with Pich Chhieng, 61, a teacher who was infected
in his native Cambodia and carried it with him to this country. He took
medication for eight months but abruptly stopped because he ran out of
money and was feeling much better.
He didn't know until he was hospitalized while visiting family in Los
Angeles that by neglecting his treatment he had allowed the disease to
mutate, and the drug-resistant bacteria had overwhelmed his lungs.
"I knew it wasn't cured yet, but I thought it wasn't that strong," said
Chhieng, who has been forced to stay in California until he is cured. "I
thought it was gone, and when it came back like that, I felt really bad.
I wanted to kill myself."
The majority of drug-resistant infections in the U.S. are brought in by
legal visitors, and health officials argue that simply tightening
immigration controls won't solve the problem.
The only visitors to the U.S. who are screened for tuberculosis and
other medical conditions are immigrant and refugee visa applicants, and
TB experts say there is no easy way to screen the millions of tourists,
workers and others who aren't currently evaluated.
Worldwide, TB kills 2 million people each year, mostly in Africa and
southeast Asia.
Of gravest concern is so-called "extensively drug-resistant" TB, which
recently killed more than 50 people in South Africa. It's been found in
limited numbers in the U.S. - 74 reported cases since 1993.
The strain is nearly impossible to cure because it's immune to the best
first- and second-line TB drugs. It is as easily transmitted through the
air as garden variety TB.
Health officials here also have been jolted by a spike in a milder but
still-lethal form called "multi-drug resistant" TB.
That's the strain afflicting Chhieng. It responds to more treatments but
can cost up to $250,000 and take two years to cure.
The number of cases of that variety are multiplying worldwide, jumping
more than 50 percent from about 273,000 in 2000 to 425,000 in 2004,
according to a study published in August in the Journal of Infectious
Diseases.
In the U.S., 128 people were diagnosed with it in 2004, a 13 percent
spike from the previous year.
Health officials say a drug-resistant outbreak like the one in South
Africa is unlikely here because of stringent public health safeguards,
but warned that more widespread infections are possible in the future
because the disease is so easily transported.
"That's a red light flashing," said Dr. Charles Wallace, an infectious
disease specialist with the Texas Department of State Health Services.
"That's a warning sign that TB is becoming more difficult to manage when
it goes untreated and undiagnosed. We always like to think that it can't
happen here, but any disease that travels through the air could be on a
plane flying here at any time."
U.S. health officials believe more money is needed for prevention and
treatment abroad.
"It certainly has outbreak potential if we don't get on it right away,"
said Dr. Kenneth Castro, director of the CDC's Division of Tuberculosis
Elimination.
The states with the highest numbers of multi-drug resistant cases in the
last decade were New York, California, Texas and Florida, according to
the CDC.
In New York City, a series of deadly HIV-related drug-resistant TB
outbreaks ripped through prisons and hospitals in the early 1990s,
killing hundreds of people, including many who had started treatment.
But mortality rates dropped dramatically after the health department
created a separate unit to target the strain, stepped up education in
multiple languages and improved coordination with doctors.
Last year, overall tuberculosis rates in the city hit their lowest point
since the peak of the most recent epidemic in 1992; however,
drug-resistant cases jumped from 18 in 2004 to 24 cases last year.
"The threat is always there," said Dr. Sonal Munsiff, director of the
city's tuberculosis control bureau. "And I think it's increasing in some
ways because drug-resistant tuberculosis is increasing worldwide. So it
doesn't take long to get a case here."
Health officials complain that federal funding has not kept up with the
increased demands of battling the disease. State and county health
departments wind up paying for uninsured patients like Chhieng, who has
six months left in his two-year treatment.
Chhieng praises the treatment he has received in the U.S. He says he has
gained weight and is feeling better, but has not seen his wife in a year
and a half. And he regrets being a burden to his daughter-in-law, who is
housing him and translates for him.
"Everything's better right now," he said. "I'm going to have a long life
to live. I really miss home. I miss my wife, I miss my country, I miss
the weather over there. I just want to go home."