March 21, 2001

Contacts:
Andrew Weisser, (818) 703-6444
aweisser@earthlink.net
or your local American Lung Association
at (800) LUNG-USA. www.californialung.org

TB Rates Continue to Decline in California
-- On World TB Day, American Lung Association Emphasizes Need for Continued Prevention and Control

(Sacramento, CA, March 21, 2001) As public health advocates worldwide mark Saturday, March 24 as World TB Day, the American Lung Association of California is calling on the State of California and local health departments to increase funding for tuberculosis prevention and control efforts. The statewide theme for this year is, "Moving Toward TB Elimination."

"Although there were about 300 fewer cases of Tuberculosis (TB) in California, comparing 1999 to 2000, there are an estimated 3.4 million Californians who are infected and can possibly become active cases," 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," she said.

Even with the decrease in overall TB cases in California, 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 eighth 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 2000, California had the highest number and the fourth highest rate of TB cases in the United States and accounted for 20 percent of TB cases in the United States. The number of TB cases in California declined 8.6 percent, comparing 1999 (3,608 cases) and 2000 (3,296 cases).

The 3,296 cases of active TB disease in 2000 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 five 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 2000, a total of 16,372 TB cases were reported from the 50 states and the District of Columbia, a decrease of 7 percent from 1999 and 39 percent from 1992, the height of the TB resurgence in the U.S. The 2000 rate of 5.8 per 100,000 population was 45 percent lower than in 1992 (10.5). The proportion of TB cases among foreign-born persons increased from 27 percent in 1992 to 46 percent in 2000.

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," Cole said. "We cannot relax simply because tuberculosis rates are declining. The numbers are dropping precisely because we have been investing in tuberculosis prevention and 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 joins with the California Tuberculosis Controllers Association to advocate for additional statewide and local health department funding," said Cole. "The current level of funding is insufficient to close the remaining gaps in TB elimination. The cost to cure a TB case has increased while we are left with some of the most difficult to treat TB cases; those that are multi-drug resistant."

"As it is not feasible to test everyone in California for TB infection or active TB disease, we must target our efforts to reach people at greatest risk including: people with close contact to someone with infectious TB; immigrants from countries with high rates of TB; inmates of correctional facilities; and people with HIV infection," Cole added.