# 4722
TB (Tuberculosis), which was once a scourge here in the US, had been thought on the brink of eradication in the western world by the 1970s.
With the advent of new and powerful antibiotics and vaccines, the age of infectious diseases appeared to be nearing its end.
In 1969, the Surgeon General of the United States, William H. Stewart, famously (and prematurely) declared, "The war against diseases has been won."
And for a time, it seemed so.
With the advent of the Salk Vaccine in 1955, we finally had the tool with which to eradicate the last great childhood scourge in this country; Polio. By 1963, an early measles vaccine had been developed, and in the late 1970s significant improvements had been made in the existing mumps vaccine.
And the tremendous victory over smallpox – now vanquished from the planet for 3 decades – seemed only to prove the point.
A couple of telling graphics from the MMWR of Dec 1999, Achievements in Public Health, 1900-1999: Control of Infectious Diseases.
The 2nd leading cause of death in the United States in the year 1900 was Tuberculosis.
By 1997, TB wasn’t even in the top ten.
But this victory was short-lived.
By the 1980s, new emerging pathogens were appearing; HIV, Hantavirus, Nipah, Hendra, Legionella, Borrelia.
And old foes were showing up again, with new and improved defenses against our armament of antibiotics, antivirals, and vaccines; MRSA, influenza, and yes . . . Tuberculosis.
As you can see by the following graphic, the downward trend in deaths from infectious diseases in the United States began to rise noticeably from its nadir reached in 1980.
Although the data above comes from the United States, the story is similar in other developed nations around the world.
Infectious diseases are making a comeback.
This past week we’ve a report on the incidence of Tuberculosis in London, England. The rate is rising, and that has some public health officials very concerned.
First, this abstract from the Journal of Public Health, doi:10.1093/pubmed/fdq046.
Recent trends in tuberculosis in children in London
J.E.T. Ruwende, E. Sanchez-Padilla, H. Maguire,
J. Carless, S. Mandal, D. Shingadia
Abstract
Background Childhood tuberculosis (TB) represents a sentinel event of recent transmission and is an indication of the effectiveness of prevention and control interventions. We analysed the trends in the epidemiology of TB in children in London aged 0–14 years between 1999 and 2006.
Methods Data were extracted from the Enhanced TB Surveillance System.
Results Between 1999 and 2006, there were 1370 cases of TB in children. Incidence was higher in older children and in girls. The incidence rates in London Boroughs varied from 0.4/100 000 to 32.7/100 000. Between 1999 and 2006, Black-Africans comprised 49.2% of all TB cases in children, children from the Indian Subcontinent 21.8% and Whites 8.5%. The proportion of cases born in the UK averaged 52.4% during this period. Of non-UK-born children 79.3% were diagnosed with TB within 5 years of entry.
Conclusions Ethnicity, country of birth and age are important risk factors for development of. With an overall TB incidence in London exceeding 40/100 000, universal BCG immunization of all neonates should be considered across all London boroughs.
For more background, we go to this summary report on the Emerging Health Threats Forum.
High incidence rate in London sparks call for city-wide BCG vaccination in early childhood
The incidence of tuberculosis (TB) in the UK capital has reached levels that should trigger the start of routine vaccination against the disease for all babies born in the city, according to research published this month. Writing in the Journal of Public Health, medical scientists say that almost 45% of all childhood TB cases in the UK are now occurring in London.
A policy of routine BCG immunisation has been in place in some North London boroughs for several years already. The vaccination is advised only for UK-born babies whose parents and grandparents come from countries with a high incidence of TB, and those born in such countries who were not immunised previously.
The jab is also recommended for children living in areas where TB incidence in the entire population exceeds 40 cases per 100,000 people. This is now seen consistently across London, say the authors.
The UK’s NHS (National Health Service) maintains a major web portal on TB information, including details on the Bacillus Calmette-Guérin (BCG) vaccine which provides protection against tuberculosis.
BCG (tuberculosis) vaccination
Who should have the vaccine?
The BCG vaccine is not given as part of the routine childhood vaccination schedule unless a baby is thought to have an increased risk of coming into contact with TB.
For example, all babies born in some areas of inner-city London (where TB rates are higher than in the rest of the country) should be offered the BCG vaccination.
BCG vaccinations may also be recommended for people who have an increased risk of developing TB, such as:
- health workers
- people who have recently arrived from countries with high levels of TB
- people who have come into close contact with somebody infected with respiratory TB
For now, TB remains less of a problem in the United States, although with greater globalization and travel, that could change. The BCG vaccine is not currently used in the US, since the incidence of the disease remains relatively low.
The CDC’s MMWR gives us the statistics for TB in the US as of 2006.
Trends in Tuberculosis Incidence --- United States, 2006
In 2006, a total of 13,767 tuberculosis (TB) cases (4.6 per 100,000 population) were reported in the United States, representing a 3.2% decline from the 2005 rate.
This report summarizes provisional 2006 TB incidence data from the National TB Surveillance System and describes trends since 1993.
The TB rate in 2006 was the lowest recorded since national reporting began in 1953, but the rate of decline has slowed since 2000. The average annual percentage decline in the TB incidence rate decreased from 7.3% per year during 1993--2000 (95% confidence interval [CI] = 6.9%--7.8%) to 3.8% during 2000--2006 (CI = 3.1%--4.5%).
Foreign-born persons and racial/ethnic minority populations continue to be affected disproportionately by TB in the United States. In 2006, the TB rate among foreign-born persons in the United States was 9.5 times that of U.S.-born persons.*
Complicating matters has been the global emergence of drug resistant strains of Tuberculosis.
Last March the World Health Organization released a sobering new report on the global spread of Multidrug and Extensively Drug-Resistant Tuberculosis (M/XDR-TB), and posted a press release on their website summarizing the problem.
Drug-resistant tuberculosis now at record levels
18 MARCH 2010 | GENEVA | WASHINGTON DC -- In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, a World Health Organization (WHO) report says.
For example, 28% of all people newly diagnosed with TB in one region of north western Russia had the multidrug-resistant form of the disease (MDR-TB) in 2008. This is the highest level ever reported to WHO. Previously, the highest recorded level was 22% in Baku City, Azerbaijan, in 2007.
With our increasingly mobile society, diseases that are today a problem in developing countries can readily find new homes in London, New York, Vancouver, Tokyo, and Sydney.
If you need more than humanitarian justification, this is reason enough to fund and support global public health initiatives, so that these threats can be dealt with before they spread any further.
