Program To Stop TB Falls Short: homeless among high-risk

Tom Boland (wgcp@earthlink.net)
Tue, 24 Nov 1998 17:12:33 -0400


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rculosis_2.html
=46WD  Philadelphia Daily News - Wednesday November 18 1:51 AM ET


PROGRAM TO STOP TB FALLS SHORT
By Brenda C. Coleman - AP Medical Writer


CHICAGO (AP) - Even the most successful programs to combat tuberculosis
fail to eradicate as many as a third of new infections, according to
research published today in the Journal of the American Medical Association.

Baltimore's model program used state-of-the-art techniques to cut the
city's TB rate from one of the highest in the nation to one of the lowest.
It was among the first to implement directly observed therapy and
aggressive contact tracing.

But the two techniques did not stop the spread of the dangerous lung
infection among casual contacts, researchers concluded in the report.

``It suggests that to bring TB rates down from low to even lower, or if one
wants to think of eradication, more is going to be needed,'' Dr. William
Bishai, the study's lead author, said in a telephone interview Monday.

In directly observed therapy, health workers observe patients take each
dose of medicine during months of treatment to ensure none is missed.
Patients may be required to take medicine daily or several times a week.

Contact tracing requires health workers to question each patient to learn
who he has exposed to the infection so that they can be notified and given
preventive therapy.

TB spreads mainly when infected people cough or sneeze bacteria into the
air, where they are inhaled by others. Incomplete therapy promotes
drug-resistant bacteria, a growing problem.

=46ewer than 20,000 new TB cases were diagnosed last year, but highly
drug-resistant TB has turned up in 43 states. Tuberculosis can be deadly if
untreated. An estimated 15 million Americans are infected with TB, but 85
to 90 percent or inactive and not infectious. No effective vaccine is
available.

Baltimore implemented directly observed therapy and contact tracing in
1981, and lowered its rate from more than 35 new cases per 100,000 people
in 1981 to fewer than 15 cases per 100,000 people in 1996.

But in the 21/2 years ending in 1996, new infections still accounted for
about one-third of all diagnoses, with the remainder being old infections
that had just begun to cause illness, researchers said.

The new cases clustered mostly in areas with high rates of poverty, poor
education, drug abuse, alcoholism and the AIDS virus, where TB control has
traditionally been difficult, the researchers said.

``A lot of the recently transmitted TB appeared to be transmitted casually
- probably between people who didn't know one another's identities,'' said
Bishai, assistant professor of international health at Johns Hopkins
University School of Hygiene and Public Health.

Contract tracing wouldn't help those people, Bishai said.

An expert not involved in the study noted that other cities have tried the
same TB-control measures for shorter periods and have found the same thing.

Creative approaches will be needed, said the expert, Dr. Peter Barnes of
the University of Texas Health Center at Tyler.

One technique could use DNA fingerprinting to locate clusters of new
infections, and then an old approach - chest X-rays - to screen everyone in
the cluster for unidentified active cases, he said.

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http://dailynews.yahoo.com/headlines/ap/ap_us/story.html?s=3Dv/ap/19981118/u=
s/tuberculosis_2.html

=46WD  Philadelphia Daily News - Wednesday November 18 1:51 AM ET=20



<paraindent><param>right,left</param>PROGRAM TO STOP TB FALLS SHORT

By Brenda C. Coleman - AP Medical Writer=20

</paraindent>


CHICAGO (AP) - Even the most successful programs to combat tuberculosis
fail to eradicate as many as a third of new infections, according to
research published today in the Journal of the American Medical
Association.


Baltimore's model program used state-of-the-art techniques to cut the
city's TB rate from one of the highest in the nation to one of the
lowest. It was among the first to implement directly observed therapy
and aggressive contact tracing.


But the two techniques did not stop the spread of the dangerous lung
infection among casual contacts, researchers concluded in the report.


``It suggests that to bring TB rates down from low to even lower, or if
one wants to think of eradication, more is going to be needed,'' Dr.
William Bishai, the study's lead author, said in a telephone interview
Monday.


In directly observed therapy, health workers observe patients take each
dose of medicine during months of treatment to ensure none is missed.
Patients may be required to take medicine daily or several times a
week.


Contact tracing requires health workers to question each patient to
learn who he has exposed to the infection so that they can be notified
and given preventive therapy.


TB spreads mainly when infected people cough or sneeze bacteria into
the air, where they are inhaled by others. Incomplete therapy promotes
drug-resistant bacteria, a growing problem.


=46ewer than 20,000 new TB cases were diagnosed last year, but highly
drug-resistant TB has turned up in 43 states. Tuberculosis can be
deadly if untreated. An estimated 15 million Americans are infected
with TB, but 85 to 90 percent or inactive and not infectious. No
effective vaccine is available.


Baltimore implemented directly observed therapy and contact tracing in
1981, and lowered its rate from more than 35 new cases per 100,000
people in 1981 to fewer than 15 cases per 100,000 people in 1996.


But in the 21/2 years ending in 1996, new infections still accounted
for about one-third of all diagnoses, with the remainder being old
infections that had just begun to cause illness, researchers said.


The new cases clustered mostly in areas with high rates of poverty,
poor education, drug abuse, alcoholism and the AIDS virus, where TB
control has traditionally been difficult, the researchers said.


``A lot of the recently transmitted TB appeared to be transmitted
casually - probably between people who didn't know one another's
identities,'' said Bishai, assistant professor of international health
at Johns Hopkins University School of Hygiene and Public Health.


Contract tracing wouldn't help those people, Bishai said.


An expert not involved in the study noted that other cities have tried
the same TB-control measures for shorter periods and have found the
same thing.


Creative approaches will be needed, said the expert, Dr. Peter Barnes
of the University of Texas Health Center at Tyler.


One technique could use DNA fingerprinting to locate clusters of new
infections, and then an old approach - chest X-rays - to screen
everyone in the cluster for unidentified active cases, he said.


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