Containing TB / Wa Po Editorial

http://www.washingtonpost.com/wp-dyn/content/article/2007/06/01/AR2007060102645.html?referrer=email



Even the United States is vulnerable to an outbreak.

Saturday, June 2, 2007; A12



THE CENTERS for Disease Control and Prevention last week issued the first federal quarantine order since the 1960s, targeting an Atlanta man infected with an extremely dangerous form of tuberculosis. For the moment there appears to be little risk of an outbreak in the United States. Nevertheless, extensively drug-resistant tuberculosis and drug-resistant strains of other diseases will threaten public health here as long as the conditions that led to their development persist, especially irresponsible antibiotic use and inadequate public health infrastructure, particularly in poor countries.

Andrew Speaker remains isolated in Denver after returning to the United States from Europe via Canada. In an interview aired yesterday, Mr. Speaker said that U.S. authorities failed to advise him strongly not to travel before he left for Europe and later gave him the impression that the CDC had "abandoned" him in Italy, compelling him to return on his own.

Even without fully accepting Mr. Speaker's claims, it appears the CDC could have better communicated with him. Further, a border guard should have stopped him as he tried to enter the United States by car. But the bottom line appears to be that, once CDC officials knew Mr. Speaker carried an extremely dangerous form of tuberculosis, they acted with appropriate urgency. Extensively drug-resistant tuberculosis (XDR-TB) is a terrifying bug. The most common forms of tuberculosis respond well to standard medication. Some strains have mutated into forms that require lengthy treatment. XDR-TB, however, deflects even these medicines, leaving patients few options. Currently, all forms of tuberculosis are rare in the United States but too common around the world: According to the international health group Partners in Health, nearly a third of the world's population carries a form of TB, and the prospect of an outbreak here is all too conceivable -- and frightening.

The best way to keep XDR-TB rare in the United States is to contain its spread in the areas of the world where it is beginning to flourish, such as Russia, Asia and sub-Saharan Africa. That will require a sustained international effort. Partners in Health has applied an impressive strategy that includes enlisting community members to ensure that patients take all of their pills on schedule, a model that the Global Fund for HIV-AIDS, Tuberculosis and Malaria says it backs financially. Such efforts cannot progress without generous sponsorship, a that fact rich nations must remember when tuberculosis, HIV-AIDS and other world health crises are discussed at the Group of Eight summit this month.

but doesn't a normal TB vaccine protect against this, or have there been suggestions of an adult booster? Anyone know?

I don't believe there is any vaccine for bacterial infections of any kind---I think they are all for viruses. Not a doctor, just a mother gone through all the shots.

against bacteria. They are called bacterins. They tend to be more problematic than viral vaccines due to increased risk of side effects and decreased immune response. We don't vaccinate against bacterial disease for the most part because we have ANTIBIOTICS to treat the diseases, unlike viruses (until recently, there WERE no safe, effective antiviral drugs, so vaccines were all we had against them).

http://www.use.hcn.com.au/subject.%60Bacterial%20Vaccines%60/home.html

Actually, I was wrong. BCG is the Tb vaccine, but we don't see it used in the US. It causes the person to test positive for TB on the skin test, which is highly undesirable.

They are still big on vaccinating over here. I guess maybe I got the smallpox vaccine mixed up with TB vaccine.

It looks like they only vaccinate for TB in areas of high risk. See info here: http://www.cdc.gov/tb/pubs/tbfactsheets/BCG.htm

Correction. BCG (bacille chalmet-guerain or whatever) is the TB vaccine they use some places, but not in the US. It makes the person a permanent positive TB reactor (a bad thing) and so drastically complicates efforts to keep track of REAL TB carriers.

http://en.wikipedia.org/wiki/Bacillus_Calmette-Gu%C3%A9rin
".....In the United States, BCG vaccination is not routinely given to adults because it is felt that having a reliable Mantoux test, and being able to accurately detect active disease, is more beneficial to society than vaccinating against a relatively rare (in the US) condition......"