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Tuberculosis still a health problem, but numbers of cases drop in King County

Tuberculosis presents an ongoing community health challenge for King County, and reflects a local symptom of a continuing global epidemic. In 2008, 121 people were diagnosed with active tuberculosis, a drop from the 30 year high of 161 cases reported in 2007. Over the past decade, reported TB cases have ranged between 121 and 161 cases annually.

Intensive TB control efforts and investments earlier in the decade to address outbreaks among homeless people and East African immigrants may be playing a contributing factor in the most recent decline in active TB cases. Because TB infection can take several years to develop into active disease, the full impact of interventions may take years to become apparent.

“We’re at a global crossroads that makes us vulnerable to a disease that infects one third of the world’s population and kills two million people every year,” Dr. David Fleming said, Public Health director. “Our TB control program is at the front lines of controlling the spread of TB. We diagnose and treat people with active tuberculosis disease and screen friends and family around them who are highest risk of infection so that infections don’t spread.”

Investments in TB control improve community health and save money by controlling the spread of TB, reducing the opportunity for outbreaks, and helping to prevent the development of multi-drug resistant forms of the disease that cost approximately $250,000 per person to cure.

In response to funding challenges for 2009 and beyond, the TB Control Program has carefully reassessed its service delivery system for controlling TB in King County. Strategies to improve program efficiencies include:

• focused use of resources on cases posing the greatest public health significance;

• community partnerships for provision of care and management of non-infectious TB cases and

• enhanced partnerships with the private sector to provide directly observed therapy and TB case management.

Key findings from the 2008 Annual Report:

• 121 people were diagnosed with active TB in King County, reflecting a decline from 161 people in 2007, 145 in 2006, 125 in 2005 and 134 in 2004.

• all nonwhite races continue to have disproportionately higher rates of TB than whites (1.6 per 100,000): African American (34.2 per 100,000), Asian American (15.9 per 100,000) and Latino (15.7 per 100,000).

• 110 people (88 percent) with active TB were tested for HIV. Of those tested, eight people are co-infected with HIV.

• 34 percent of people with active TB in King County came from East Africa, 21 percent of people from Southeast Asia and 15 percent from Central America.

• Eight people who had active TB were resistant to at least one TB medication. Three people had multi-drug resistant (MDR) TB, making them especially difficult and costly to treat.

• 13 people (11 percent) diagnosed with active TB were homeless.

“Despite that fact that tuberculosis is both preventable and curable, controlling TB is an ongoing challenge,” Dr. Masa Narita said, TB control officer for Public Health. “We estimate that about 100,000 people live in our county with latent, or dormant, TB infection. They are not contagious now, but in the future latent TB can progress to active TB disease, where people can potentially transmit the disease to others.”

Background on tuberculosis

Tuberculosis is an infectious disease caused by the bacteria called mycobacterium tuberculosis.TB usually involves the lungs (pulmonary TB) but can affect almost any organ in the body. TB is almost always curable with antibiotics that are readily available in countries such as the United States.

People with active TB disease are made sick by bacteria that are active in their body. People with dormant, or latent, TB infection are not sick because the germ is inactive inside their body, and they cannot spread TB infection to others.

With no convenient preventive medications or an effective vaccine, it is unlikely that TB will be eliminated in the near future. TB generally infects the most vulnerable populations of the world, often impacted by poverty, malnutrition and overcrowding.

More information is available at Public Health’s Tuberculosis Control Program.

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