Tuberculosis

Yes, people still get TB. In fact, we currently have about 20 cases of active TB in Durham. MMWR this week is all about TB. It's got a lot of words, but if you scroll down, there are tables and graphs.

Something I learned in pharmacy school was that the rate of TB in the US had decreased pretty well... until about the mid-80s, when the Reagan administration slashed funding for state/county health departments to administer TB treatment by directly-observed therapy (which is the most effective method, as TB treatment per current guidelines involves 4 drugs for 2 months, followed by at least 2 drugs for 4 more months - at a minimum. If your sputum doesn't clear on 4 drugs, or you're immune suppressed (eg HIV+), you get at least 9 months of therapy.)

The MMWR data shows that the majority of active TB in the US is in recent immigrants. When you hear people say things like "why treat TB with extensive therapy in places like Africa? It's too expensive?" they're wrong on so many levels. First because they're placing a very low value on other people's lives. Second because ineffective treatment leads to antibiotic resistance - MDR-TB has spawned XDR - TB. Put 1 and 2 together, and you get immigrants with MDR- or XDR-TB, who spread it to their contacts in the US.

Actually, it's sad that it takes pointing out that it could affect us here to get people to care.

TB anywhere is TB everywhere is written by an epidemiologist (whose blog I discovered by blogroll surfing.) It's a good read.

Comments

Years ago, I tested positive for TB

Had been working as Front Desk Manager at The Holly Inn. The Dining Room Manager was from Spain and would come to my office to smoke. He was constantly coughing and hacking, then mysteriously disappeared for 6 months. When he returned, there was a rumor that he went home to be treated for TB. My next job was at a Nursing Home where I had to be tested. For years, I had been tested for TB, every time the Fair came to Moore County because I was in the Jaycettes and we ran a food booth. Always tested clean. I had a year treatment, then was told that if I ever get really, really sick, I will probably get full blown TB. Oh, this was in the 80's.

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I don't know about that.

The assumption is that if you complete the course of INH, it's killed off any bacteria that are floating around, so you're clean. But if you work in a health field and need annual skin testing, it'll always be positive, so they have to do annual chest X-rays instead.

Some places do a 2-step test, where they administer one PPD, read it, and rechallenge with another PPD a few weeks later, on the notion that some people's immune response wouldn't be mounted by a single challenge. I have no idea if there's any evidence for doing that. I do know, however, that in HIV, they'll often place a second antigen, usually Candida albicans (common yeast), to make sure the immune system is functional enough to mount a response.

I think infectious diseases are really fascinating. I also found out today that I was accepted into the Certificate in Field Epidemiology online program at UNC. So I'm probably going to write about cool things I learn.

Congratulations!

I can't wait to read about the cool things you are learning.

Robin Hayes lied. Nobody died, but thousands of folks lost their jobs.



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Vote Democratic! The ass you save may be your own.

Glad to know that

always worried about that, like something hanging over my head. I am not in the food service field and don't get tested every year. Do you think that's something I need to do? Like I said, this was in the 80's.

No matter that patriotism is too often the refuge of scoundrels. Dissent, rebellion, and all-around hell-raising remain the true duty of patriots.

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