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March 24, 2006

Tuberculosis (TB): Good News & Bad News

***It's World TB Day - Learn More***

Tuberculosis cases declined to an all-time low in the US in 2005 -- down to 14,093. That's the good news, says the CDC.

The bad news, however, is that TB is becoming resistant to the antibiotics used to fight it (primarily isoniazid and rifampin). Between 2003 and 2004, the number of US residents with "multi-drug resistant" (MDR) TB increased by 13 percent. Most of those cases involve immigrants from Mexico, the Philippines and Vietnam. MDR TB cases now comprise one percent of all US TB cases -- while that is a tiny percentage, it's a sign of what's to come.

A survey of international TB cases found that 20 percent were MDR and 2 percent were "extensively drug-resistant," according to an AP story. What does that really mean?
"It's basically a death sentence. If people are failing first- and second-line drugs and we don't have in the pipeline a new drug for immediate use, that's a crisis," said Dr. Marcos Espinale, executive secretary of the World Health Organization's Stop TB Partnership.
The problem [is] worst in Latvia, where public health care deteriorated after the Soviet Union collapsed. Doctors believe TB develops resistance to drugs because some patients fail to complete a full course of medication.
U.S. multidrug-resistant cases rose from 2003 to 2004, from 113 to 128. Though the number was small, it represented the largest single-year increase in more than 10 years. Ninety-seven of those 128 cases were in people born in other countries, mostly Mexico, the Philippines and Vietnam.

Overall, the TB rate in the United States has never been lower. In 2005, about 14,100 cases were reported, or 4.8 cases per 100,000 people. That is a 4 percent decline in the rate from 2004. However, the TB rate in foreign-born people in the United States was 8.7 times that of U.S. natives.

"Worsening resistance around the world poses a problem in the U.S.," Castro said.

Dr. Henry Blumberg, an Emory University medical school professor, said the figures are preliminary and the problem may be bigger than the numbers indicate.


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