Download Tuberculosis Control: Think Globally, Act Locally

Tuberculosis Control:
Think Globally, Act Locally
Sponsored by:
Sen. Richard T. Moore and Rep. Peter J. Koutoujian
and
American Lung Association of Massachusetts
Boston University School of Public Health
Massachusetts Infectious Diseases Society
Massachusetts Public Health Association
The Medical Advisory Committee to Eliminate Tuberculosis
Partners in Health
RESULTS
TB-Not Gone, but Forgotten?
Tom Garvey, MD, JD
Chair, Subcommittee on Government Relations, Medical
Advisory Committee to Eliminate Tuberculosis
Harvard Clinical Fellow, The Cambridge Hospital
What is Tuberculosis?
“The white plague”
“Consumption”
“The English disease”
“Pthisis”
“Decay”
“The captain of all the
men of death”
Transmission
a TB sanitorium in the late 1800s
The End?
Tuberculosis II:
The Cycle of Neglect
28000
26000
24000
22000
20000
18000
16000
14000
12000
10000
83
85
87
89
91
93
95
97
99
US Tuberculosis Case Rates by Year
2001
MDR TB 1993-1998
Multidrug-Resistant TB (MDR TB)
• Presents difficult treatment problems
• Treatment must be individualized
• Requires longer courses of more expensive,
more toxic, less effective medications
• Requires directly observed therapy (DOT) to
ensure adherence
Factors Contributing to the Decrease in
TB Morbidity Since 1993
Increased efforts to strengthen TB control programs that
• Promptly identify persons with TB Identify contacts
to persons with infectious TB; evaluate and offer
therapy
• Test high-risk groups for latent (i.e. not active) TB
infection; offer therapy as appropriate
• Initiate appropriate treatment
• Ensure completion of therapy by directly
observed therapy (DOT)
Directly Observed Therapy (DOT)
Patient observed swallowing each dose of medication
Preferred public health practice in therapy of TB
Partial treatment of infection selects for drug resistant
surviving TB germs.
Key to getting patients to take a complicated regimen for 6
months.
In countries where anti-TB drugs taken w/o supervision,
higher incidence of resistance.
Thus, the state needs to support the staff needed for DOT to
protect the public health.
Cost of the New York Outbreak
1. Human costs (incalculable)
2. Emergence of new, more deadly strains
of tuberculosis
3. Diversion of health resources away
from other problems
4. State monetary: Ten times x cost
savings of cutting prevention
5. Total monetary: >$1 billion
The Trend in Massachusetts
• Because of general cuts to public health, local
health departments are laying off public health
nurses--the eyes and ears of TB control
• We have shut down 4 out of 23 Tuberculosis
clinics in the last 2 years, most problematically in
Framingham and New Bedford, where there are
high-risk populations
• Proposals have been floated to charge patients for
secondary TB tests and TB medications
Conclusions
• Tuberculosis continues to be one of the leading
threats to human health.
• Although it is preventable and curable, relaxation
of the effort to fight it has disastrous
consequences.
• Our TB clinics are an irreplaceable barrier against
the epidemic through their concentration of
expertise, their TB tracking and outreach
resources, and directly observed therapy.
Recommendations:
– That no further cuts be made to the Department of
Public Health
– That a separate line item for tuberculosis clinics be
created
– That funding for existing clinics be maintained
– That the clinics be restarted in Framingham and New
Bedford and a new one be founded in Quincy since
these are potential breeding grounds for an epidemic
– That no barriers, including fees be applied to
tuberculosis testing and treatment