Many American baby boomers perceive tuberculosis to be a relic of the past, like polio. In past centuries, the disease killed millions of Americans,...

Many American baby boomers perceive tuberculosis to be a relic of the past, like polio.

In past centuries, the disease killed millions of Americans, including historical figures such as President James Monroe and Eleanor Roosevelt.

Then, in the 1940s and ’50s, effective drug therapies were developed, and experts predicted the eventual elimination of TB.

Yet TB remains a massive killer worldwide, accounting for 2 million deaths annually. And it’s the leading cause of death for people infected with HIV, including in the United States.

The U.S. rate of TB has been declining. Last year, a total of 10,521 new tuberculosis cases were reported in the U.S., an incidence of 3.4 cases per 100,000 people. That’s the lowest rate recorded since national reporting began in 1953, the CDC says.

But Georgia’s tuberculosis rate, though dropping, is still higher than the national average. Georgia reported 347 TB cases (3.5 cases per 100,000 population) in 2011, a 16 percent decrease from 2010.

The disease in the state is largely centered in three counties in metro Atlanta — DeKalb, Fulton and Gwinnett.

The state Department of Public Health reports that in 2010, the most recent year with available data for population estimates by race and ethnicity, the highest TB case rate was in Asians (24.1 per 100,000), followed by Hispanics (8.2 per 100,000), and non-Hispanic blacks (7.1 per 100,000).

The cost of containing a live outbreak can be ‘‘phenomenal,’’ says state Sen. Renee Unterman, who represents a Gwinnett district. Unterman’s advocacy helped inject an extra $350,000 in the state budget for treating TB in those three counties.

“In Lilburn, where I grew up, we started seeing a rising incidence of TB,’’ Unterman says.

Two years ago, 50 students and faculty members at Lilburn Middle School tested positive for exposure to tuberculosis during a public health screening. Here’s an AJC article from 2010 about the school’s TB problem.

Most infections become the non-contagious and asymptomatic latent TB. One in 10 of those cases, though, converts to the contagious, symptomatic, active TB disease.

In Gwinnett, as well as nationally, the disease hits foreign-born residents disproportionately hard.

Alana Sulka, director of epidemiology for the Gwinnett, Newton and Rockdale public health district, says many TB patients “come from areas that are high in TB.’’

There is also a higher incidence in prisons and jails, Sulka says.

Labor-intensive monitoring

In DeKalb County, where the highest number of TB cases in Georgia has occurred, the district health director wrote a letter in October to the state’s commissioner of Public Health, requesting funding for legal expenses incurred for TB confinement cases.

If people have active symptoms, they are confined for four to six weeks in a quarantine-like situation.

The letter gives a stark picture of the disease in DeKalb.

“DeKalb TB cases are among the most complicated, with 67 percent of the individuals being foreign-born, representing 18 countries; and thereby, presenting with language and cross-cultural needs,’’ wrote Dr. Elizabeth Ford, the health director for DeKalb.

Of the TB patients in fiscal 2010, 18 percent had HIV, and 12 percent were homeless, ‘‘and a significant number had a history of alcohol and drug abuse,’’ Ford said in the letter.

The primary cost of the public health TB response involves increased staff workload and time. Public health officials manage active cases by using direct observed therapy, where staffers must watch the patients take their medications. Failure to take medication can harm the patient and even contribute to development of drug-resistant infections.

This need for one-on-one monitoring has strained the public health budgets. “There’s not enough public health personnel to deal with the situation,’’ Sulka says. Here’s a GHN article last year on the public health financial burden.

Gwinnett’s rate dipped last year, Sulka says, but it remains about double the national rate.

The TB case count in Fulton County dropped from 81 in 2009 to 45 in 2011. Fulton County Department of Health and Wellness credits prevention efforts focused on the homeless population, especially people who are HIV-infected.

“This included major screenings for active and latent TB at some of the larger shelters in the county,’’ says April Majors, a spokeswoman for the public health agency.

Poverty is a key factor

Meanwhile, important research on TB is under way in Atlanta.

Jyothi Rengarajan, a TB researcher at the Emory Vaccine Center, says that she came to Atlanta mainly because it had a relatively high incidence of the disease, which would aid her research.

Rengarajan and other researchers are studying people who have latent TB infections but no active symptoms. They are analyzing how the immune system responds to infection. A goal is to be able to predict which healthy person with a latent infection will progress to active TB disease.

Many metro Atlanta patients end up at Grady Memorial Hospital, the state’s largest safety-net hospital.

Dr. Susan Ray, who is working with Rengarajan on the TB research and practices at Grady, says the disease typically surfaces in people living in crowded conditions, those with HIV, and people with substance abuse problems.

The average person does not need to fear being infected with TB, Ray says.

(Eleanor Roosevelt, though a wealthy woman all her life, made a point of visiting and working with the poor and the sick, and traveled abroad extensively, and probably was exposed to TB during those visits.)

The Georgia public health system is doing a good job on tuberculosis, Ray and Rengarajan say.

“This is a disease of poverty,’’ Rengarajan says. “If you eliminate poverty, you eliminate TB.’’

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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