To access related data, visit: http://www.cdph.ca.gov/programs/tb/Pages/default.aspx
(Oakland, CA, March 23, 2009) While tuberculosis (TB) cases dropped 1.1 percent in California (2008 compared to 2007), increases were experienced in 19 of California’s 61 local health jurisdictions. In recognition of World TB Day on March 24, and Stop TB Week, March 23-27, the American Lung Association in California is urging the state of California to avert a resurgence of TB by increasing funding for prevention and control efforts.
"TB is a worldwide public health epidemic that knows no borders," said Barbara Cole, RN, MSN, PHN, a volunteer board member with the American Lung Association in California. "Although TB is usually completely curable, it kills 250 Californians every year and infects thousands more."
There were 2,696 cases of TB reported in California in 2008 compared to 2,725 cases in 2007. California continues to report the highest number of TB cases in the United States. The TB case rate in California is 60 percent higher than the rest of the country.
In 2008, TB case increases were seen in Colusa, Contra Costa, El Dorado, Fresno, Kern, Lake, Long Beach, Madera, Mendocino, Monterey, Nevada, Pasadena, San Bernardino, San Joaquin, Santa Barbara, Stanislaus, Sutter, Tulare and Ventura.
An estimated 2 million Californians are infected with the bacterium that causes tuberculosis. Most of those who are infected don’t know it because their infection is “latent” or inactive and doesn’t make them or others sick. But if and when it becomes active, TB can be deadly if not treated. If the infected Californians are not located and treated, 100,000 of them could develop active TB in their lifetimes. TB usually activates in the lungs, making the person sick and infectious.
TB is transmitted through the air when an individual with active TB in the lungs coughs or talks. It takes six months or more for appropriate medications to cure active TB disease. Anyone inhaling air containing the TB bacteria may become infected. Patients with latent TB infection should be evaluated for treatment to prevent progression to active TB disease.
While California’s TB case rate decreased slightly in 2008 to 7.0 cases per 100,000 residents (from 7.2 in 2007), the state is far from the national 2010 objective of one TB case per 100,000.
Funding Needed to Prevent Resurgence
Despite the decreasing number of cases in California, there has been a leveling off in the rate of decline since 2001, compared to earlier years. This slowing in the rate of decline mirrors the decrease in state and local resources available for TB control. TB resurgence is a concern of everyone involved in California TB control programs.
Every Californian’s health is at risk due to under-funded TB prevention and control programs,” said Trisha Murakawa, American Lung Association in California board chair. "California stands at the crossroads of a global epidemic that has a significant impact on our state. Californians travel around the world for work and leisure, and millions of people come to California from other countries each year as tourists and immigrants."
In fiscal year 2001-2002, $400,000 was cut from the State TB Control Local Assistance Budget. In the current fiscal year, $953,000 (10 percent) of the State TB Control budget, including the Local Assistance Budget, was cut (through across-the-board cuts that affected all state programs).
Cuts from county boards of supervisors and local budgets create the most significant threat to an effective statewide TB prevention and control program. A recent survey of local TB control programs requested by the CDC found that 120 positions in TB control statewide have been lost due to budget cuts in the last three years. That is more than 10 percent of TB control jobs reported lost in the nation in the last three years, in the state with 20 percent of the nation’s TB cases.
"More than 100 years after the American Lung Association was formed out of a public health necessity to control TB, the battle is still not won," said Cole. "As we have seen in the past, when the government cuts funding for the prevention and control of TB, there is a resurgence of this potentially deadly disease. With the rise of multi-drug resistant forms of TB, the consequences of budget cuts are potentially even more deadly. The American Lung Association in California, along with others, continues to urge policymakers to fully fund TB prevention and control in California."
The state experienced a TB resurgence after local, state and federal prevention and control funding was cut in the late 1980s when TB was perceived as no longer a threat. After the resurgence, funding was increased and cases started to decline from 5,382 reported at the height of the California epidemic in 1992.
While acknowledging that state and local governments are facing serious budget shortfalls, the American Lung Association in California believes that delaying the restoration of important TB control resources may put the state at risk for enormous future health expenditures should a serious TB outbreak occur.
Multi-Drug Resistant TB Raises the Stakes
Multi-drug resistant TB is more costly and more difficult to treat. With multi-drug resistant TB, many of the antibiotics used to fight the bacteria do not work.
Inappropriate or incomplete therapy can lead to TB patients developing and spreading strains of multi-drug resistant TB. About 80 cases of multi-drug resistant TB are under treatment in California each year.
Recently, extensively drug-resistant TB (XDR-TB) has emerged worldwide; which are strains that are virtually untreatable due to their resistance to a multitude of drugs. Nineteen cases of XDR-TB have been detected in California since 1993. The World Health Organization (WHO) has reported that multi-drug resistant TB is at the highest rate ever and XDR-TB has been found in more than 50 countries. According to WHO estimates, there are about 500,000 new cases of multi-drug resistant TB worldwide each year.
WHO estimates one-third of the world’s population, or about 2 billion people, carry latent TB. Ten percent of those with latent TB will develop active TB in their lifetime. Worldwide each year, 8 to 10 million people become infected with TB and 2 million people will die from it. Worldwide TB is a leading cause of death for people with AIDS.
World TB Day Calls for Action
Everyone can take an active role in helping people gain access to accurate TB diagnosis and effective treatment. People with TB can become active participants in their own cure and reduce the spread of multi-drug resistant forms by taking all their medications as prescribed. Healthcare professionals can stop TB by staying alert to the symptoms and provide prompt diagnosis and treatment. Scientists can stop TB by engaging in needed research to develop new diagnostic procedures, medicines and vaccines. Teachers can stop the spread of TB by educating their students about the contagious disease. And policymakers can stop TB by allocating adequate funding for prevention and control efforts in our front line public health TB control programs across California.
Also needed to eliminate TB are new and more effective drugs, diagnostic procedures and a vaccine. Today’s TB drugs are more than 40 years old and as we have seen, the bacteria are building up a resistance to them. The only TB vaccine available today is more than 85 years old and provides only some protection against severe forms of TB in children, but is unreliable against pulmonary TB. Simpler, faster drug regimens that treat all forms of TB; rapid, more accurate diagnostic tools to quickly detect TB; and a vaccine that will be effective in preventing TB in people of all ages are urgently needed if we truly want to stop this worldwide epidemic and serious public health threat.
