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July 1, 2007
America's Wake-up Call on TB
 
By Congressman Gene Green
 
Washington, DC - The recent news surrounding the travels of XDR-TB carrier Andrew Speaker has provided Americans with insight into what much of the world already knows: Tuberculosis continues to be one of humanity’s greatest health threats, and its drug-resistant forms will quickly spread beyond our control unless significant commitments are made to stop it. Some of my early memories are of visiting my uncle, who was quarantined with tuberculosis at our VA hospital after returning from Army service in Italy during World War II.
 
             In 2005, more than 1,500 cases of TB were detected in the State of Texas, with 379 new cases in Harris County alone.  With an infection rate of 10.2 individuals per 100,000 people here, TB prevalence is higher in Harris County than in Texas overall (6.7 cases per 100,000 people) and the United States (4.8 cases per 100,000 people). 

Officials from the Centers for Disease Control and Prevention (CDC) testified recently to Congress that extensively drug-resistant tuberculosis (XDR-TB) arose from the failure of health systems worldwide to effectively treat tuberculosis. Almost 1.6 million people in the world still die each year from TB because they lack access to effective treatment, despite the fact that TB has been curable for more than half a century.

Once their symptoms subside, many TB patients fail to complete their course of treatment, which typically lasts six to nine months. As a result, evolving mycobacteria often become resistant to treatment with first-line drugs. It is estimated that about 450,000 such cases – known as multi-drug-resistant tuberculosis (MDR-TB) – develop each year. Treatment for MDR-TB involves the use of harsher and more expensive second-line drugs, increasing the difficulty and cost of treatment. Of the TB cases diagnosed by the Harris County Public Health and Environmental Services Department, seven percent of those from our community were found to be drug-resistant strains. 

 

Just as MDR-TB develops when first-line drugs are misused or mismanaged, XDR-TB can develop when treatment with second-line drugs is not completed. XDR-TB is virtually untreatable, and patients with XDR-TB can transmit the deadly strain in the same manner that regular TB is passed on.  A cough or sneeze is all it takes.

 

In its report entitled Ending Neglect: The Elimination of Tuberculosis in the U.S., the Institute of Medicine found that the domestic resurgence of TB in the late 1980s and early 1990s was largely due to federal funding reductions.  The same report also stated that a federal approach to TB that included proper funding, improved prevention and control activities and the development of new treatments and vaccines could eliminate TB as a public health problem in the United States.

 

We should learn from our previous inattention to this disease, which is why I have introduced the Comprehensive TB Elimination Act (H.R.1532).  This legislation will give the Centers for Disease Control (CDC) authority to respond to international outbreaks of XDR-TB and increase funds for the Center’s National Program for the Elimination of Tuberculosis. It will expand research on TB diagnostic and treatment tools at the National Institutes of Health and CDC so that we may have new tools to combat the disease.

 

The recent attention to domestic TB by the news media should startle all Americans from the complacent notion that TB cannot touch our lives here. The sobering reality is that we cannot stop TB anywhere unless we work to stop it everywhere.

 

Rep. Gene Green represents the 29th Congressional District of Texas and serves as the Vice Chairman of the House Energy and Commerce Committee’s Health Subcommittee.

 

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