New TB strain in South Africa a concern

By, Celean Jocobson, Associated Press, April 7, 2007

JOHANNESBURG, South Africa - The extent of the deadly new strain of tuberculosis in South Africa and the region is not known and is cause for concern, an international health expert said Wednesday.

Dr Fabio Scano, a TB expert from the World Health Organization in Geneva, has been sent to South Africa at the request of the government to assist with the outbreak of the extensively drug-resistant tuberculosis strain, or XDR-TB.

"We don't know the extent of multiple drug resistant and extreme drug resistant TB in sub-Saharan Africa and the southern African region. There is not yet the capacity to test in these countries," Scano said at a news conference.

South Africa has reported 352 cases of the virulent strain since it was discovered last year in the eastern KwaZulu-Natal province. There have been 221 deaths and concerns have been raised about the strain spreading across the region.

Scano said an epidemiological investigation was under way to determine the full extent of the disease.

"I don't think the situation in KwaZulu-Natal is unique," said Professor Ronnie Green-Thompson, special adviser to the health minister. "If we test in other provinces we may well find a similar prevalence."

Multiple drug resistant TB, known as MDR-TB, does not respond to a "first line" of drugs while the extreme strain does not respond to a "second line" of drugs.

Africa is the only continent where TB rates are increasing and the disease is complicated by high rates of HIV infection, which lowers a person's immune system.

"MDR-TB and XDR-TB and the way they are magnified by HIV infection is the biggest public health challenge both nationally and internationally," Scano said.

He said that without the drug resistant strain, 12-14 percent of TB patients who have HIV die because of the "lethal combination" of the two diseases.

Scano said WHO was committed to working with South Africa to address the challenge presented by the disease.

"There are a lot of interventions under way but we have yet to see the results ... the fight against TB is a marathon, not a sprint. But there is a need for action now," he said.

Drug resistance grows when people do not complete a grueling six month regime of medication, and South Africa has a low adherence rate.

Part of the two-year collaboration between WHO and South Africa is to ensure greater adherence of patients to the treatment programs.

The health department has had to force a number of XDR-TB patients back to hospital after they tried to return to their homes and in the United States, a 27-year-old man suffering from the extreme strain has been locked up indefinitely as a danger to the public.

Nthari Matsau, Deputy Director-General of the health department, stressed that while it was important to separate TB patients, issues of discrimination and human rights had to be considered.

"Incarceration is not an ideal way of separating TB patients. There are much more acceptable and humane ways," she said.

Scano said new drugs to treat XDR-TB were now available in South Africa but he said there was a huge need for new medicines to be developed to combat the disease.

"Unless there is massive investment in new drugs, we won't make headway in the fight against TB. We have to do the best we can with what we have," he said.

Drug-resistant diseases pose civil liberties dilemmas

By, Chris Kahn, Associated Press, April 7, 2007

PHOENIX - Behind the county hospital's tall cinder-block walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since July. But he has not been charged with a crime. Instead, he has an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

"I'm being treated worse than an inmate," Daniels said in a telephone interview last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."

Though Daniels' confinement is extremely rare, health experts say it is a situation U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy organization.

World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.
HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.

How to deal with people infected with the new strain is a matter of debate.

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.

"We're on the verge of taking what was a curable disease, one of the best-known diseases in human endeavors, and making it incurable," Upshur said.

But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.

"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."

In the United States, which had 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.

Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.

Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s and saw a significant dip in cases.

In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.

Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for ailing criminals. He said sheriff's deputies will not let him take a shower - he cleans himself with wet wipes - and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

He said that he lost 50 pounds and was constantly coughing, and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

"Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But, in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.

"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

"Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."

Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am"


Source: http://www.twincities.com/ci_5616093?source=rss

Deadly combination of TB and HIV

By, IRIN PlusNews, March 28, 2007

The tiny mountain kingdom of Lesotho, already burdened by the third highest HIV infection rate in the world, is struggling to contain a parallel epidemic of tuberculosis (TB).

In 2006 alone, 12,000 of Lesotho's 1.8 million inhabitants were diagnosed with TB, but experts like Peter Saranchuk, of the international medical relief organisation, Medecins San Frontieres, believe the actual number of people suffering from the disease is probably much higher.

Challenges for diagnosis

It is estimated that as many as half of all adults in southern Africa carry a latent form of TB, but people with HIV-compromised immune systems are 50 times more likely to develop active TB.

The sputum tests most commonly used to detect TB often fail to recognise it in HIV-infected patients. Because the proportion of TB patients co-infected with HIV in Lesotho is one of the highest in the region - 85 percent to 92 percent - Saranchuk estimates that the amount of undiagnosed TB is "vast".

In most of the HIV-positive patients with negative sputum test results, the most reliable way to diagnose TB is by culture testing, in which samples are cultivated in a special liquid. But Lesotho has very limited capacity to do culture testing; samples must be sent to neighbouring South Africa and it takes about six weeks to get results.

A machine used to prepare the samples at the country's largest hospital, Queen Elizabeth II in Maseru, has been broken for over a year. Staff at the TB outpatient clinic at nearby Botsabelo Hospital told PlusNews they were still waiting for the results of cultures sent to Queen Elizabeth in May 2006.

Where culture testing is unavailable or simply too slow, TB in HIV-infected patients can be diagnosed by means of x-rays and clinical assessments. But this approach is relatively new and Lesotho's department of health and social development is still in the process of training health workers in the co-management of the two infections.

According to Saranchuk, many doctors will still only initiate TB treatment based on a positive sputum test. "That patient will keep getting antibiotics and keep getting sicker, even though they do have TB," he said.

"The TB world hasn't adjusted to the fact that there's this explosion of co-infection going on in Southern Africa," added Rachel Cohen, MSF's head of mission in Lesotho. "It hasn't filtered down yet to nurses at the primary care level, who are the ones faced with sputum-negative patients who are going to die of TB if they don't do something to treat them."

In one of Lesotho's 17 health districts, where MSF is managing HIV/AIDS and TB care and treatment at 14 clinics and one district hospital, nurses are being trained in how to diagnose TB using x-rays and other indicators, but elsewhere in the country only doctors can initiate treatment in sputum-negative cases.

Need for integration

Until recently, there was little coordination between Lesotho's TB and HIV/AIDS programmes. As in most countries in the region (see www.nature.com), patients accessed TB and HIV treatment at different sites and there was little collaboration between health professionals working on the twin diseases.

Now the department of health and social development has a TB/HIV strategy that includes training health workers and lay counsellors in both TB and HIV, routinely offering HIV testing to TB patients, screening HIV patients for TB, and providing TB and HIV treatment at the same site.

But, according to Dr Michael Sekokomala, head of Lesotho's largest TB outpatient clinic at Botsabelo Hospital, in the capital city of Maseru, implementing this strategy still has a long way to go. The clinic lacks enough counsellors to provide HIV testing to all patients, and those who are co-infected still have to make separate appointments to access antiretroviral (ARV) treatment at a nearby HIV/AIDS clinic.

Maneo Lesole, who works at a local garment factory to support her three children, misses up to five days of work a month to attend appointments at both clinics. "They deduct my pay for each day I miss," she said. "After deducting I get maybe 500 maluti (US$68), instead of M650 (US$88)."

Directly Observed Short-Course Treatment (DOTS), in which volunteer community health workers are trained to monitor TB patients while they take their medication, is the norm; HIV patients undergo intensive adherence counselling to make sure they understand the importance of taking their medication every day, without supervision.

Lesole, who received ARV-adherence counselling before she began TB treatment, quickly informed the community health worker assigned to monitor her TB medication that she was used to taking drugs on her own.

MSF favours a more patient-centred approach to TB-drug adherence, based on its experience of ARV treatment. Patients and their "treatment supporters", who can be family members, attend 'TB school', where they learn about possible side-effects, the consequences of not completing their treatment and what they can do to avoid infecting household members.

"We've learned that empowering patients is the key to long-term adherence," said Cohen. "When people really understand about the risks of drug resistance, they're going to take their medicines every day."

Shoeshoe Matsoele, deputy manager of Lesotho's TB control programme, believes the DOTS approach can be adapted to incorporate ARV adherence. She sees no reason why volunteers trained in DOTS, whether community health workers or family members, cannot also be trained to monitor ARV drug adherence.

Drug resistant TB threat looms

In neighbouring South Africa, multidrug-resistant TB (MDR-TB) is on the rise. MDR-TB is often the result of TB patients failing to finish their 6-month course of drugs and is particularly dangerous and difficult to treat in people living with HIV.

XDR worries us very much, because if we can't manage MDR, how can we manage XDR?
Even more alarming, virtually untreatable extremely drug-resistant (XDR) strains of TB emerged in South Africa's KwaZulu-Natal Province in 2006 and have since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive patients.

As culture testing is the only sure way of diagnosing MDR-TB, Lesotho is at a severe disadvantage in assessing the seriousness of its MDR-TB problem and dealing with it.

"We don't know how many MDR cases we have," said Dr Sekokomala. "We just have MDR suspects, so XDR worries us very much, because if we can't even manage MDR, how can we manage XDR?"

Sekokomala is convinced that XDR-TB is already present in Lesotho because of the number of patients he has lost while they were being treated. The lack of infection control in Lesotho's TB wards and clinics is particularly worrying: staff at his clinic have now received protective masks, donated by Partners In Health (PIH), an international medical non-profit organisation, but an HIV-positive nurse died of TB before they arrived, despite being on treatment.

The Lesotho government is still finalising emergency guidelines for dealing with MDR and XDR-TB, and recently entered into an agreement with PIH to open a 40-bed isolation ward for MDR-TB cases at Botsabelo Hospital. It is expected to open in May of this year.

In the meantime, Sekokomala is forced to admit patients with suspected MDR to the TB ward at Queen Elizabeth II Hospital. "There's only a corridor separating the TB ward from the children's ward, and children play in that corridor," he said.

Dr Jennifer Furin, director of PIH in Lesotho, has been impressed by the government's rapid response to the threat of MDR and XDR-TB. Her biggest concern is not the lack of an isolation ward, but the potentially high number of unidentified MDR-TB cases: "In reality, these patients are everywhere and they're coughing, and there's really no way to isolate them."

ks/he/kn

Source: http://www.irinnews.org/Report.aspx?ReportId=70888

SWAZILAND: Tuberculosis still killer number one

By, IRIN PlusNews, April 4, 2007
Tuberculosis (TB), aggravated by HIV/AIDS, remains chief cause of death in Swaziland, which holds the dubious record of having the most TB infections in the world per population.

Cesphina Mabuza, Director of Health Services for the Ministry of Health and Social Welfare, told IRIN there were 186 TB patients per 100,000 people, and "of the 8,500 reported cases in the country, all are on some form of treatment."

However, 60 cases scattered across three of Swaziland's four regions indicate that a strain of TB has developed that is resistant to normal TB medication. These multidrug-resistant tuberculosis (MDR-TB) patients are being kept in isolation for the first phase of possible treatment at government hospitals.

"Ordinarily, TB should respond to treatment within two months. If improvement is not forthcoming, that is evidence of MDR-TB presence," Mabuza said.

"What we call TB first line is the type that could be treated the ordinary way. There is also MDR, which is resistant to treatment but can be curable with stronger drugs. Then there is XDR [extremely drug-resistant], which is difficult to treat," said Themba Dlamini, Programmes Manager at the Ministry of Health.

Dlamini said no cases of XDR had been identified in Swaziland yet, but without the necessary testing facilities available in the country it was impossible to rule out the possibility. Very few countries in Africa have the technology to test for drug-resistant TB and the health ministry is liaising with its counterpart in neighbouring South Africa, where MDR-TB is on the rise, to send specimens from Swazi TB patients to Pretoria, in South Africa, for testing.

MDR-TB is often the result of TB patients failing to finish their 6-month course of drugs, and is particularly dangerous and difficult to treat in people living with HIV. Even more alarming, XDR strains of TB emerged in South Africa's KwaZulu-Natal Province in 2006 and have since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive patients.

It is estimated that as many as half of all adults in southern Africa carry a latent form of TB, but people with HIV-compromised immune systems are 50 times more likely to develop active TB. Without sophisticated laboratory facilities, TB patients co-infected with HIV also present a diagnostic challenge.

The degree of prevalence of TB amongst people living with HIV/AIDS is not known and, despite the AIDS crisis, hard data is often lacking.

The correlation between Swaziland's record TB infection rate and its HIV-infection rate - at 36.8 percent of the sexually active population also the highest in the world - has not been lost on health officials.

Of all patients admitted to Swaziland's hospitals and private clinics, 25 percent suffer from TB, and one out of four deaths at these facilities are TB related.

Lack of space at government hospitals has led to the establishment of a TB centre at the National Psychiatric Centre in the eastern commercial town of Manzini, the country's only facility for the mentally ill. The presence of dissimilar patients in the same centre has prompted concern in parliament, increasing the pressure on health ministry officials to open a new TB Hospital in Moneni, east of downtown Manzini.

Health Minister Njabulo Mabuza told members of parliament that the hospital would soon be open, and the first functioning wards would be dedicated to patients with MDR-TB and XDR-TB.

According to recent health ministry statistics, only twelve percent of Swazis know whether they are HIV positive or not. "There is an urgent need to maximise access to knowledge of one's HIV status, and achieving universal access to HIV prevention treatment, care and support," said Rejoice Nkambule, National Coordinator of the health ministry's Health Education Unit.

Stigma against people living with HIV/AIDS remains strong. "People still do not wish to know their status because they fear being ostracised by their families, friends and co-workers. It happens. TB is a good 'cover story' for many people living with HIV and AIDS, because when they fall sick they blame it on the TB and not AIDS," said Noah Fakudze, a voluntary testing counsellor in Manzini.

At a World TB Day celebration at Manzini's public square on 24 March, people co-infected with HIV and TB testified to the crowd that they could live long and productive lives despite these diseases.

"No one should feel ashamed because they fall sick. The good news is that treatments are here. If you live right, and get tested, you might not even need those treatments," said a woman in her twenties named Rose, who said she had been HIV-positive for eight years and was recently cured of TB.

jh/tdm/he


Source: http://www.irinnews.org/Report.aspx?ReportId=71139

TB Victim Is Locked Up in Arizona

By, Chris Kahn, Associated Press, April 2, 2007

Behind the county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

"I'm being treated worse than an inmate," Daniels said in a telephone interview with The Associated Press last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."

Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.

The World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.

HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.

How to deal with people infected with the new strain is a matter of debate.

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.

"We're on the verge of taking what was a curable disease, one of the best known diseases in human endeavors, and making it incurable," Upshur said.

But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.

"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."

In the United States, which had a total of 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.

Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.

Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s, and saw a significant dip in cases.

In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.

Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals. He said sheriff's deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here, and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

He said that he lost 50 pounds and was constantly coughing and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

"Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.

"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

"Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."

Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am."


Source: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/04/02/national/a112253D39.DTL&feed=rss.news

TB cases still occur in U.S.

By, Emily Berry and Mary Fortune, timesfreepress.com, April 1, 2007

Though tuberculosis largely is considered eradicated in developed countries, the airborne disease still infects thousands in the United States and millions worldwide each year, health care experts said.

“The rates of active TB in the U.S. have been steadily declining for the last 50 years, but it still occurs,” said Dr. Stephen Hawkins, a physician who specializes in infectious disease and is medical director of the tuberculosis clinic at the Chattanooga-Hamilton County Health Department.

Last week, a series of miscommunications in the investigation of a local case of tuberculosis led to about 30 workers being sent home from their second-shift jobs at the Pilgrim’s Pride chicken plant in downtown Chattanooga.

On March 8, a former worker at the plant was found to have tuberculosis, and the health department sent letters to employees Thursday who may have worked closely with the employee more than a year ago.

“We were just recommending notification and testing,” said Donna Needham, com- municable diseases program manager for the health department.

No one has been found to have contracted tuberculosis as a result of contact with the former employee, nor has anyone in the person’s home or church community, Ms. Needham said.

Dr. Hawkins said when someone in the work force tests positive for active tuberculosis, health department staff try to establish who at the person’s workplace worked most closely with the infected person.

“Tuberculosis is an airborne disease, but the bacteria does not survive well in the environment,” he said.

Dr. Allen Craig, state epidemiologist for the Tennessee Department of Health, said “the risk is greater the closer you are to a person with tuberculosis and the longer you’re there.

“It can be spread in the workplace, but it’s less common than it is in the home,” he said.

Cases of tuberculosis dropped rapidly in the 1940s and 1950s with the advent of effective antibiotic treatments. But the number of cases in the United States began to rise again in 1985, according to the U.S. Centers for Disease Control and Prevention.

The rise was caused by factors including the spread of HIV and AIDS, which compromise the immune system; increased numbers of foreign-born residents ; and increased numbers of long-term care facility residents, according to the National Institute of Allergy and Infectious Diseases.

The annual tuberculosis rate has decreased since 1992, but the rate of decrease has slowed and the proportion of tuberculosis cases among foreign-born people has increased each year since 1993, according to the CDC.

Dr. Hawkins said the high number of foreign-born tuberculosis patients has prompted the health department to start outreach to immigrant populations.

The health department has Spanish-language translators on staff, and Dr. Hawkins said he learned Spanish to serve better the Hispanic immigrants he treats.

“An increasing percentage of new cases of active TB are occurring in immigrants,” he said. “Worldwide it’s an enormous problem.”

But, Dr. Craig said, the rates of tuberculosis infections are decreasing both nationally and in Tennessee. And when infection and illness occurs, it’s easily treated with antibiotics, he said.

Erlanger spokeswoman Pat Charles said the hospital typically is only aware of patients with tuberculosis if they are being treated for the advanced stages of the disease.

Last year only one patient tested positive while still at the hospital, Ms. Charles said.

E-mail Mary Fortune at mfortune@timesfreepress.com

E-mail Emily Berry at eberry@timesfreepress.com BY THE NUMBERS

8.8 million: New tuberculosis cases reported worldwide, 2005

13,767: Tuberculosis cases reported in the United States in 2006

18: Tuberculosis cases in Tennessee reported so far in 2007

279: Total tuberculosis cases in Tennessee reported in 2006

7: Total tuberculosis cases in Hamilton County reported in 2006

504: Total tuberculosis cases in Georgia reported in 2006

196: Total tuberculosis cases in Alabama reported in 2006 Source: Tennessee Department of Health, North Georgia Health District, Centers for Disease Control and Prevention


Source: http://www.tfponline.com/QuickHeadlines.asp?sec=l&URL=http%3A%2F%2Fepaper%2Etfponline%2Ecom%2FWebChannel%2FShowStory%2Easp%3FPath%3DChatTFPress%2F2007%2F04%2F01%26ID%3DAr01304