Everett, Wash.
Published: Saturday, March 22, 2008

GUEST COMMENTARY

Let's get serious about drug-resistant TB

By Dr. Lee B. Reichman

 It took a high-profile case of an American air traveler with tuberculosis last year to call America's attention to the threat of drug-resistant TB. But as Monday's World TB Day approaches, it appears the United States is finally getting serious about addressing this crisis.

Six years ago, I warned that drug-resistant TB was a ticking timebomb. Most recently, the World Health Organization reported that of the 9 million new TB cases in the world each year, about half a million are MDR-TB. Drug-resistant TB is spreading faster than ever before. Extensively drug-resistant TB (XDR-TB), the most dangerous form of the disease, has now been detected in 45 countries, including the United States. The actual number of countries with XDR-TB is almost certainly higher, since many countries lack the capacity even to make the diagnosis. One has to wonder whether the timebomb has already been detonated.

The key to controlling and halting the spread of drug-resistant TB is the ability to diagnose TB patients in a timely manner, and ensure that they take their full course of medicine. This way, it is ensured that the strain will not return as a more resistant, and therefore more difficult and expensive to treat, form of tuberculosis. With few resources, this can be difficult to manage in developing countries and wealthy countries like the U.S. But programs like our Global Tuberculosis Institute in Newark, N.J., show what is possible when the resources and the will are applied to help control TB.

Recently the World Health Organization's Web site featured Michael Berrian, a 42-year-old homeless man who has benefited from the vigilance of the Newark program. After being diagnosed with TB, he was placed under treatment and kept in isolation at a hospital until he was no longer contagious. Upon release from the hospital, the state branch of the American Lung Association arranged for his stay in a studio apartment for the duration of his six-month treatment.

To ensure Berrian completed his treatment, health worker Rebecca Stevens was assigned by our institute to bring him his medication each day. Stevens also delivered restaurant and grocery store vouchers to Berrian to ensure adequate nutrition during his course of treatment. Thanks to this comprehensive system of support, Berrian is making a complete recovery, and most importantly, his tuberculosis won't turn in to MDR-TB and won't infect anybody else.

With the political commitment and modest investments globally, we can make sure all patients have an uninterrupted drug supply and support to complete treatment. Not only could this save more than 1.5 million lives a year, but it can prevent further drug-resistance.

We have seen what is possible when we have the tools and the data necessary to combat TB, but there's a tremendous gap in resources. Many poor nations with high rates of TB -- especially in sub-Saharan Africa -- lack the capacity to ensure strong programs and lack the ability even to test for drug-resistant TB.

With weakened immune systems, people with HIV/AIDS are far more susceptible to getting sick with TB. With Africa -- where TB is the No. 1 killer of people with HIV/AIDS -- bearing the heaviest burden of the AIDS epidemic, health officials fear the region could become a flashpoint for an epidemic of MDR-TB and XDR-TB that could literally roll back the progress made in AIDS treatment scale-up.

Recognizing the link between TB and the survival of people living with HIV/AIDS, Congress wisely chose to include major funding for global TB efforts in the legislation reauthorizing the president's AIDS Initiative. The House Committee on Foreign Affairs and the Senate Committee on Foreign Relations have passed versions of the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, which would authorize $4 billion over the next five years in critical resources for TB treatment and prevention worldwide. Both bills also make provision to scale up life-saving TB-HIV efforts and allocate $2 billion for the Global Fund to Fight AIDS, TB and Malaria in 2009. As these bills move forward for a full vote by the Senate and House, it is critical that these TB provisions be included.

Years ago, I felt like a voice crying in the wilderness about the perils of drug-resistant TB. While it's gratifying to see that the message has finally gotten through, we must make up for lost time in the race to stop this catastrophe before it spirals beyond control. We may yet still have time to defuse the MDR-TB time bomb.



Lee B. Reichman, M.D., M.P.H., is executive director of the New Jersey Medical School Global Tuberculosis Institute, and is professor of medicine, preventive medicine and community health at the New Jersey Medical School of the University of Medicine and Dentistry of New Jersey in Newark.





World TB Day event

You’re invited to become part of the global movement to eliminate tuberculosis by attending an event in Snohomish on Wednesday night.

The free event, co-sponsored by Snohomish County RESULTS and the Snohomish Health District, will feature stories and music about people affected by TB. It’s at 7 p.m. at the Wired and Unplugged Internet Cafe, 717 First St., Snohomish.
© 2009The Daily Herald Co., Everett, WA