Originally created 08/17/99

CDC says enhanced efforts needed to eliminate tuberculosis



ATLANTA -- In an effort to stamp out the last remnants of tuberculosis in the United States, federal health officials on Thursday unveiled a plan that calls for new methods of treating and preventing the sometimes deadly disease.

Great strides have been made in lowering TB rates -- now at an all-time low of seven cases per 100,000 people -- but doctors are worried that drug-resistant strains of TB may be spreading. That, combined with complacency and global TB outbreaks, could cause a resurgence in the United States.

"We're interested in seeing tuberculosis become a disease of the past but it's not yet," said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention. "We have to be mindful that the disease is still with us and in some parts of the country we are not seeing the national decline."

Tuberculosis is an airborne disease spread only through prolonged, close-quarters contact. In most cases, it is easily cured. But if the disease goes undiagnosed or untreated, it can be fatal.

Since 1992, TB cases in the United States have decreased 31 percent, reaching a record low of 18,361 last year.

But between 1992 and 1997, the number of TB cases increased six percent among people born in another country. And drug-resistant strains were reported in 43 states and Washington, D.C.

The outline released Thursday by a federal advisory council to the CDC is similar to a strategic plan to eliminate TB released in 1989.

A TB vaccine exists, but it has proven ineffective in adults. The report said a new vaccine is crucial, as are long-term sources of private and public money to support vaccine research.

Rifapentine, the first new anti-TB drug in 25 years, was just approved last year by the Food and Drug Administration. And few pharmaceutical companies are involved in TB drug development.

The report said that strategies targeting high-risk groups -- including people with HIV and prison inmates -- have been poorly applied and that treatment measures are often underused or inadequate. Among the underused methods of treatment cited was directly observed therapy, which many experts have called the best way to eradicate TB.

In directly observed therapy, health workers make sure patients take each dose of medicine during their months of treatment. Patients may be required to take medicine daily or several times a week.

The American Lung Association puts the costs at fighting TB at more than $900 million. In a statement released Thursday, the group urged Congress to approve $320 million to support the battle.

"We have inexpensive tests to diagnose tuberculosis. We have drugs to cure it. We have public health strategies to prevent its spread," said Ernest P. Franck, president of the group. "What is missing is a more aggressive financial commitment from Congress."