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September 1996
Despite Recent Decline in TB Cases CDC Cautions That Battle
Against Disease Is Not Over
National TB Controllers Workshop Addresses TB
Prevention and Control Efforts
The nation's state and big city tuberculosis (TB) controllers will convene at the Centers
for Disease Control and Prevention (CDC) National TB Controllers' Workshop on September 5-7 at
8:30 a.m., at the Crowne Plaza Ravinia Hotel, to develop strategies to prevent a resurgence in
TB cases and related drug-resistant TB. CDC announced a third consecutive yearly decline in
U.S. TB cases for 1995, reflecting the effective use of resources for TB prevention and
control. However, CDC officials caution against prematurely declaring a victory over TB for
several serious reasons:
- Drug-resistant TB is a continuing problem, with sporadic outbreaks of
multidrug-resistant TB (MDR TB) being reported on a regular basis. Individual
drug-resistant cases now occur in most of the nation. State TB control officials are
modifying their recommended anti-TB treatment regimens to address these resistant strains,
which require costly additional drugs and longer regimens to ensure cure and prevent
further spread.
- There have been sporadic reports of TB due to strain "W", which is an often
deadly MDR TB strain involving resistance to several of the primary drugs used to treat
TB. This strain was initially reported in New York City, and has now been reported in
other areas of the country, most recently in the southeastern United States. During the
meeting, CDC will request health departments to promptly report any TB cases due to this
strain to ensure adequate treatment is provided for these patients.
- A study of the nation's sickest MDR TB patients provides evidence that poorly
administered treatment programs do more to foster the emergence of drug resistance than no
treatment at all. One published study showed that an average of four mistakes per patient
-- (1) inadequate initial regimens, (2) improper modifications of initial regimens, (3)
insufficient drug susceptibility testing, and (4) failure to provide adherence promotion
strategies -- have been made in the past; mistakes that could have been prevented. Also,
further studies show that these mistakes may still be occurring.
- Foreign-born TB cases increased 10.6% between 1992 and 1995, in contrast to a 24%
decline in TB cases among U.S.-born persons observed during this time. CDC is presently
enhancing efforts to prevent and control TB among foreign-born persons, which include
conducting additional screening of new arrivals and directing intervention measures to
immigrant populations at highest risk for TB.
- TB had been known as a disease that primarily affects elderly persons; it is now
increasingly seen in younger populations as well. During the last 10 years (1985 to 1995),
there was a 3.0% increase in the number of reported cases nationwide. However, in children
aged 0 to 14 there was a 23.6% increase.
- Almost 23,000 cases are still reported annually in the United States, and 20 of the 50
states (40%) last year reported either no change or an increase in TB.
"This is not a time for celebration, but a time for cautious and guarded
optimism," said Dr. Kenneth Castro, Director of CDC's Division of TB Elimination. Health
officials are working with
CDC and health care providers across the United States to confront these new challenges.
Dr. Castro noted that the decline in TB cases for the third consecutive year is primarily due
to increased funding for state TB prevention and control programs, which translated into a
reinvigoration of these programs. "The programs are developing and implementing effective
activities such as recruiting and retaining skilled staff and improving laboratory
capabilities for the prompt diagnosis of TB."
He added that "we need to continue and enhance collaborations with our international
partners -- we as a global community can unite to fight this disease." CDC is currently
conducting or participating in mutual projects in Vietnam, Manila, Mexico, Thailand, and
Africa (Botswana, Uganda, and Côte d'Ivoire).
The decline in U.S. TB cases clearly demonstrates that present activities have contributed
to the numerous successes in the battle against TB and MDR TB. But the war is not over.
"To eliminate this disease, efforts must be concentrated on sustaining current activities
and ensuring that every TB patient has the best possible chance for a cure," said Dr.
Castro.
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