Staying on top of TB

When is a disease in decline not good news? When that disease is as potentially lethal as tuberculosis, also known as TB, and its numbers aren’t falling fast enough. It remains such a public-health concern that the California Legislature recently passed a bill, signed by Gov. Jerry Brown, to help with eradication efforts.

The Centers for Disease Control and Prevention (CDC) reported a slight decrease in TB cases nationwide last year compared to 2010, though California was one of 12 states that exceeded the national rate of 3.4 instances per 100,000 people. (California’s rate was 5.8, an all-time state low since TB reporting began in the early 1980s. Neither the CDC nor the California Department of Public Health has released figures for the year in progress.)

The CDC report concludes that “the 6.4 percent decline from 2010 to 2011 … falls short of the 2010 goal of TB elimination (less than one case per 1,000,000) set in 1989. If current efforts are not improved or expanded, TB elimination is unlikely before the year 2100.”

The report goes on to say: “Addressing the increasing difference between TB rates in foreign-born and U.S.-born persons is critical for TB elimination … Progress toward TB elimination in the United States will require ongoing surveillance and improved TB control and prevention activities. Sustained focus on domestic TB control activities and further support of global TB control initiatives is important…”

That’s where California’s new law comes in.

Senate Bill 659, authored by state Sen. Gloria Negrete McLeod (D-Chino), adds TB screenings to the state’s immunization registry. As Negrete McLeod explained to California Healthline, this change will enable health officials to better track and coordinate immunizations, and “parents will have an easier time demonstrating compliance with the requirements of local school districts.”

Dr. Mark Lundberg, Butte County’s public-health officer, is particularly pleased about the development.

“In Butte County, we had been really pushing to have the TB skin test put in the registry,” he said in a recent phone interview. “It’s a handy place to put the skin-test result in the [medical] record. It’s a nice format for recording TB skin tests. So we’re very glad this happened, and we’re working to adapt our practice [at Butte County Public Health clinics].”

Even before the passage and signing of SB 659, tuberculosis made headlines several times this year.

As reported in the CN&R’s Healthlines section, a dozen cases of drug-resistant TB were reported in Mumbai, India; a Stockton man was arrested for refusing to take his TB medicine, and 35 newborns were exposed to TB in neonatal intensive-care units (NICUs) in Sacramento and Fairfield. Just last week, news broke that eight newborns were exposed to TB at a different Sacramento hospital’s NICU, though a county health official said the babies were doing well and hadn’t exhibited symptoms.

“Most every year in Butte County, we have active tuberculosis cases that occur,” Lundberg said. “We’re considered a low-risk county by state standards, but we do have cases, so there is a risk of exposure.”

What is TB? The California Department of Public Health (CDPH) describes it thusly: “Tuberculosis is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body, such as the kidney, spine and brain.”

Transmitted through the air, usually via the coughs and sneezes of infected people, TB can be fatal and, in fact, once was the leading cause of death in the United States. “However,” CDPH continues, “not everyone infected with TB bacteria becomes sick.

“People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease.

“People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.”

Lundberg stresses that last sentence.

“Before TB infection becomes TB disease, it’s more easily treated,” he said. “If we treat it at that stage, we can preclude it from becoming the disease and you don’t run the risk of spreading it to families and loved ones.”

The number of tuberculosis cases dropped dramatically in the 1940s and ’50s after the development of new treatments. TB made a resurgence in the mid-’80s for a variety of reasons. According to Medicine.org, they include:

• Increased numbers of immigrants from countries where TB is prevalent. (This accounts for more than half the cases in the United States.)

• HIV/AIDS, since patients of this disease are more vulnerable to TB.

• Crowded shelters and prisons, “where people weakened by poor nutrition, drug addiction, and alcoholism are exposed” to TB.

• Elderly people in nursing homes “whose general health has declined” or “develop active TB from TB infection they had much earlier in life.”

• TB patients who don’t take all their prescribed medicines and, thus, stay contagious for a longer period of time.

Along with screening via skin test, Lundberg said there now is a blood test that can be administered along with other blood testing. Either way, for those who haven’t been tested—particularly folks who are a native of, or have lived in, TB-prevalent places such as Africa, Asia, Latin America or Eastern Europe—Lundberg recommends doing so. It’s all the better when patients agree to having their information on the registry.

“In general, not enough high-risk people get tested and too many low-risk people get tested,” Lundberg said. “It just depends on people’s risk factors.”