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American Lung Association Says World TB Day 2000 'No Time To Celebrate—Yet'

(Sacramento, CA, March 23, 2000) — As public health advocates worldwide mark Friday, March 24 as World TB Day, the American Lung Association of California is calling on the State of California and Congress to increase funding for domestic and international tuberculosis-control efforts.

"World TB Day 2000 is not a celebration. There is no victory—yet," said Barbara Cole, RN, MSN, PHN, a volunteer board member of the American Lung Association of California and member of its Tuberculosis Technical Advisory Group. "It is very important that opinion leaders become aware of the continued public health threat that TB presents throughout California."

Although tuberculosis (TB) cases have decreased overall in the California and the United States in recent years, it is still a serious threat to public health in much of the world and specific U.S. communities. The decline in TB cases for the seventh consecutive year in California reflects major accomplishments in the fight against TB, however, the state is still recovering from the 1985-92 resurgence when the number of new cases rose 54 percent.

In 1999, California had the highest number and the second highest rate of TB cases in the United States and accounted for 21 percent of TB cases in the United States. The number of TB cases in California declined 6.4 percent, comparing 1998 (3,855 cases) and 1999 (3,608 cases). The 3,608 cases of active TB disease in 1999 are only the tip of the iceberg of people with latent TB infection.

An estimated 3.4 million Californians (10 percent) are infected with the TB bacteria. Each of these people has on average, a 5 percent risk of progressing to active TB during his or her lifetime. This would result in approximately 3,000 new active TB cases per year for the next 60 years, each of which can in turn spread TB to others.

In addition, TB rates among California's Hispanics, African Americans and Asians are 5 to 15 times higher than those for non-Hispanic whites. Each year in California, more than 300 people die before completing TB treatment.

According to the Centers for Disease Control and Prevention, based on provisional data, in 1999, a total of 17,528 TB cases were reported from the 50 states and the District of Columbia, a decrease of 5 percent from 1998 and 34 percent from 1992, the height of the TB resurgence in the U.S.

The 1999 rate of 6.4 per 100,000 population was 39 percent lower than in 1992 (10.5). The proportion of TB cases among foreign-born persons increased from 27 percent in 1992 to 43 percent in 1999.

TB is the world's deadliest infectious killer, taking the lives of 2 to 3 million people in 1999. Ten to 15 million people in the United States are infected with tuberculosis. More than one million of those people will eventually develop active tuberculosis and could spread it to others.

"Regardless of the number of people with TB in counties throughout California, it is cheaper to prevent the spread of tuberculosis than it is to treat people who are living with TB," she said. "We cannot relax simply because tuberculosis rates are declining. The numbers are dropping precisely because we have been investing in tuberculosis control. If this support erodes, we face an inevitable increase in tuberculosis. The next time around, re-establishing control will be far more costly."

After more than three decades of declining tuberculosis rates, in 1970 Congress stopped providing funding specifically earmarked for TB in favor of general block grants for a wide variety of public health programs. Lulled into complacency by declining TB rates, many states chose to spend little or nothing on TB. As a result, from 1985 to 1992, TB increased 20 percent nationwide. Among children, the increase was 35 percent. In the early 1980s, Congress reversed its failed block grant experiments. By 1992, substantial funding had been restored targeted solely to fight TB and TB rates began declining.

To sustain the current momentum, the American Lung Association of California is urging Congress to approve $330 million for domestic TB programs for fiscal year 2001 and approve legislation introduced by Reps. Sherrod Brown (D-OH) and Constance Morella (R-MD) and Sens. Barbara Boxer (D-CA), Gordon Smith (R-OR) and Frank Lautenberg (D-NJ) to allocate $100 million for the U.S. Agency for International Development's TB-eradication efforts.

"That's just a fraction of the estimated $1 billion needed to eliminate TB worldwide, but it's a start and would encourage other countries to donate as well," said Cole. The $100 million would build on $35 million Congress allotted last year.

World TB Day this year coincides with a conference of health and finance ministers from around the world, meeting in Amsterdam to examine TB in the context of social and economic development. The March 22-24 conference is hosted by the partners in the STOP TB Initiative, including the American Lung Association. Through STOP TB and the Ministerial Conference, the ALA is calling on policymakers in the United States and around the world to allocate adequate resources to fight TB.

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