To many Americans, tuberculosis (TB) may seem like an obscure disease; perhaps one they were once tested for during a pre-employment or school physical. But for people in some countries, tuberculosis infection is a real threat, the symptoms are well known, and the death toll is still too high. With the emergence of resistant strains of TB, currently used medications are becoming less effective, and for some strains, treatment is extremely difficult.
And TB is more common than you may think. About one-third of the world’s population is currently infected with TB, with one new infection occurring every second. Not all infected people are sick with active TB; in fact, 90 percent have “walled off” the bacteria within their lungs and are not ill. But the other 10 percent will develop active, contagious tuberculosis each year, and each person who develops active TB will likely infect at least 10 to 15 other people before he is treated.
Tuberculosis Is All About Human Contact
Eradicating tuberculosis infection in a particular country isn't a matter of simply providing a clean water supply or non-contaminated food — it's about setting up an organized system for recognizing the infection, treating it, and reducing transmission from person to person.
"Tuberculosis is a disease that is transmitted only from humans to human, so there are no sources from water, no sources from animals," says J. Walton Tomford, MD, staff physician with the Infectious Diseases Department at the Cleveland Clinic. "It's only from contact, usually with someone who has active lung tuberculosis." Tuberculosis is spread by the tiny droplets that become airborne when a person with active TB coughs.
Preventing Tuberculosis Infection
Limiting transmission sounds simple in principle, but it is an elusive goal for many countries. To stop the spread of tuberculosis, people must be treated as soon as they contract it.
The United States has an extremely low incidence of tuberculosis — around 12,000 to 13,000 new diagnoses per year. That’s because the United States has the human resources, an existing healthcare system, and funds needed for controlling the disease. Many countries have none of these things. And those countries, including many in Asia and Africa, are still plagued with high numbers of tuberculosis cases, says Dr. Tomford.
"What you need to control tuberculosis is effective medications, which parts of the world either can't afford or can't administer," he says.
"You also need an effective public health infrastructure, by which I mean active tuberculosis control clinics that are given the money and resources to treat cases that are contagious," he adds. The public health system also needs to evaluate, and if necessary, treat people who have come into contact with an infected person to keep them from developing and spreading active tuberculosis disease.
Tuberculosis Infection Outside of the United States
As recently as 40 years ago, tuberculosis was still a huge threat in England, and one of the primary causes of death for hundreds of years there.
So how did the British bring it under control? They did so through methods similar to those used in the United States. They focused on improving crowded living conditions to help reduce the spread of the infection and improving nutrition to boost each individual’s general health and immunity. They also developed superior methods to diagnose the disease early, using skin testing, and better drugs to manage the disease. A dedicated public health program was created for diagnosing and treating TB. Using those methods, a once enormous public health threat was brought under control.
The French have also been able to keep the incidence of TB cases very low, though they're now changing their focus for better control. They're shifting away from widespread use of the BCG (Bacille Calmette-Guérin) tuberculosis vaccine (which is not used in the United States), and focusing more on ways to prevent, contain, and treat tuberculosis. The goal is to boost awareness of tuberculosis, diagnose it sooner, and treat it — better, and earlier.
Raising Awareness of TB
So what does awareness have to do with it? Everything. The more people know about tuberculosis and the importance of stopping the spread of the disease, the more focus — and funds — can be shifted toward stopping it.
Case in point: New York City. About 25 years ago, says Tomford, there was very little attention and awareness paid to tuberculosis in New York City — and it became a huge problem.
"The funding was not proper and the public health infrastructure declined, and they had an influx of patients," says Tomford. "All those factors plus the HIV epidemic actually led to an increase in the tuberculosis rate in this country." People with HIV infection have lowered immunity to diseases such as tuberculosis, and may be more difficult to treat.
As a result, the city spent millions of dollars to reverse the trend and bring tuberculosis back under control. "Had attention been paid to that all along, I don’t think the situation would have gotten as serious as it did," he says.
To remain successful in the fight against tuberculosis, keeping awareness high and funds dedicated is essential. "If people don't continue to pay attention to tuberculosis, I fear that the rate of decline will flatten," says Tomford.
World TB Day and Other Campaigns
In the United States, there are doctors who specialize in, and focus on, treating and preventing the spread of tuberculosis. These doctors are knowledgeable about spotting and promptly treating the disease, and making sure citizens are aware of the importance of treatment.
But it's also important to raise awareness internationally. Here are some campaigns attempting to do that:
Tuberculosis is an international problem — so the solution has to be an international one too.