World TB Day: Global epidemic, local threat

KING COUNTY, WASHINGTON – Approximately one third of the world's population is infected with tuberculosis (TB), and two million people die from it every year. Tomorrow, March 24 is World TB Day, an opportunity to focus on solutions to a devastating global epidemic that continues to present local health challenges. In 2008, 121 cases of active TB were reported in King County, with four out of five of those infected born outside the United States.

Locally, Public Health – Seattle & King County's TB Control program ensures that people with active tuberculosis are diagnosed and cured and that contacts at highest risk of infection are screened, so that infections do not spread to others.

"As an international community, King County is more vulnerable to diseases like tuberculosis, which are more common in other countries than our own," said Dr. David Fleming, Director and Health Officer for Public Health - Seattle & King County. "By investing locally in TB control, we're improving the community's health and saving money by controlling the spread of TB, reducing the opportunity for outbreaks, and helping to prevent the development of multi-drug resistant forms of the disease that can be very expensive to treat."

A broken public health funding system is putting TB control activities in King County at risk. Already, the TB Control program has reduced staff and services to the highest priority cases and contacts. A stable, long-term funding solution for local public health agencies in Washington state is needed to ensure that critical services like TB control continue to protect and improve community health.

King County TB statistics for 2008:

• 121 people were diagnosed with active TB, for a rate of 6.5 per 100,000 population; the national rate for 2008 was 4.2 per 100,000. There were 161 cases in 2007, which was a 38-year high.
  
• 81% of infected individuals were born outside of the United States. Individuals were predominantly from South-East Asia, East Africa and Central America. Over half of these individuals had spent five or more years in the United States prior to diagnosis.
• All non-white races continue to have disproportionately high rates of TB.
• 10 people (8%) treated for active TB were resistant to at least one TB medication.
• King County also reported three cases of multi-drug resistant TB (MDR-TB), with three additional cases of MDR-TB diagnosed in other United States locations and treated in King County.
  
• 88% of people with active TB knew their HIV status, and 8% of those were HIV-infected.
• 13 people who were homeless within a year prior to TB diagnosis were diagnosed with TB.

"We estimate approximately 100,000 people in King County have latent, or dormant, TB infection. While they aren't contagious now, they could potentially have active TB in the future and also infect others," said Dr. Masa Narita, TB Control Officer for Public Health - Seattle & King County. "TB is curable and preventable, but controlling TB is an ongoing challenge, especially with fewer resources to accomplish our work."

The TB Control program in King County provides:

• case management of patients with active TB disease in order to assure the cure of their TB, stop further transmission of TB and prevent development of multi-drug resistant TB
  
• timely and thorough contact investigations around active TB cases to identify, evaluate and treat those who were exposed and/or recently infected

Background on TB

Tuberculosis, also called TB, is an infectious disease caused by a bacterium named Mycobacterium tuberculosis. TB often involves the lungs (pulmonary TB) but can infect almost any organ in the body. TB is almost always curable with antibiotics that are readily available in countries such as the United States.

People with active TB disease are made sick by bacteria that are active in their body. People with inactive, or latent, TB infection are not sick because the germ is inactive inside their body, and they cannot spread TB infection to others.

For more information on Public Health's TB Control Program and activities, visit: www.kingcounty.gov/health/tb.