A highly drug-resistant tuberculosis found in only 13 states six years ago has spread to 42 states, although the total number of the hard-to-treat TB cases nationwide has declined, federal researchers say.
More than 21,000 people got some type of TB last year in the United States and more than 1,400 died of it in 1994, the latest year for which mortality figures are available, according to the Centers for Disease Control and Prevention.
But in the past few years, a form of TB that resists the two drugs normally used to cure the bacterial infection has spread throughout the country.
From 1993 through 1996, a total of 1,457 multi-drug resistant TB cases were recorded, which is about 2.2 percent of the roughly 66,000 TB cases that appeared in the United States during the same period.
However, the number is on the decline: There were 488 cases of multi-drug resistant TB in 1993, but only 237 cases in 1996. Still, the numbers could climb back up, warn researchers.
“All states must be prepared to deal with drug-resistant TB,” said Dr. Marisa Moore, lead author of the CDC report published in Wednesday’s issue of the Journal of the American Medical Association.
Tuberculosis, which often strikes the lungs and is curable, experienced a resurgence 12 years ago after the United States relaxed its TB prevention efforts. Although TB has since fallen off, slowing efforts to stamp it out would be a mistake, say researchers.
“This is really a war we’re in … and now is not the time to abandon the battle,” said Dr. Lee B. Reichman, executive director of the New Jersey Medical School National Tuberculosis Center.
Reichman did not participate in the CDC study, but did write an editorial accompanying it.
Because TB is curable, many doctors support forcing treatment on people who resist help and are considered public health threats. Most of the uncooperative TB patients in the United States are among the homeless and mentally ill, and two-thirds are said to be past or present abusers of alcohol or drugs.
Wednesday’s edition of the Journal also included the results of two state efforts at treating uncooperative TB patients.
California found that jailing uncooperative TB patients to ensure they finish therapy resulted in 84 percent of them completing treatment.
However, Massachusetts reported it was able to get 98 percent of such patients to complete treatment through a special program of voluntary and involuntary hospitalization.
Forced treatment might be unnecessary if sufficient community services were available for substance abusers, the homeless and the mentally ill, suggested Reichman, who is based at the University of Medicine and Dentistry of New Jersey in Newark.
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