Tuberculosis cases are on the rise, but public health agencies say they lack the resources to respond ⋆ Michigan Advance

Until the coronavirus outbreak, tuberculosis was the world's deadliest infectious disease, killing about 1.5 million people a year.

Contrary to popular belief, the disease remains active in the United States. The number of tuberculosis cases in the United States briefly declined at the beginning of the pandemic, but the number of tuberculosis cases in 2022 will increase by 5% to 8,300 from 7,874 in 2021, according to the latest numbers from the federal Centers for Disease Control and Prevention. Did. In 2022.

Nationally, the numbers are still lower than pre-pandemic levels, but in some states, including Alaska, Nevada, South Carolina and Washington, they are below pre-pandemic numbers, according to a CDC report citing state data. exceeds.

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Public health experts say the number of tuberculosis cases in the United States is increasing, but recognition is lagging. Additionally, state and local health officials lack the resources to continue prevention and control efforts.

The disease spreads through the air when an infected person coughs or sneezes. A bacterial infection that usually attacks the lungs but can also affect other parts of the body, such as the kidneys, spine, and brain. It is usually treated with multiple antibiotics for 4 to 9 months. In the United States, a course of treatment for one TB case can cost approximately $20,000, and a case of drug-resistant TB can cost at least $182,000.

Anyone can get tuberculosis, but foreign-born people, Hispanics, Blacks, Asian Americans, Pacific Islanders, and Native American communities are especially affected, according to the CDC. In total, about 88% of U.S. cases in 2021 were among racial and ethnic minorities, officials report. Experts say this is a product of structural barriers to health care and more crowded living conditions.

Black, Hispanic, and Indigenous people are also more likely to be incarcerated, homeless, and infected with HIV, all of which are risk factors for the disease.

“People think tuberculosis is gone. … It's here and it's increasing,” said emergency medicine physician Dr. George Benjamin, executive director of the American Public Health Association, which represents public health professionals. said.

Benjamin said a lack of resources is complicating state, local and federal efforts to control the spread of the virus.

For every tuberculosis patient, contact tracers track 10 to 15 people who may have been infected, said Donna Hope Wegener, executive director of the American Tuberculosis Coalition, which represents state, city and territory tuberculosis program managers. They say they have to spend time tracking people. .

Since 1994, funding for CDC's tuberculosis eradication division has declined by about 60 percent, adjusted for inflation, according to a department analysis provided to Wegener.

An analysis by the Association of State and Territorial Health Officials noted that public health spending increased significantly in 2020 and 2021 in response to the COVID-19 pandemic, but the analysis found that since 2016, public health He also pointed out and warned that the number of vacancies in the department has increased rapidly. Impact of reduced funding post-pandemic.

A recent report by the Trust for America's Health, a nonprofit research and advocacy organization, found that “state and local health departments should use pandemic response funds to address other public health programs and infrastructure needs. As a result, many long-standing deficiencies remain unresolved.”

“[Tuberculosis] The program is expected to do more with less funding,” Wegener said. “I've heard it said on some shows that we're basically in a crisis situation right now.”

State and local initiatives

In Alaska, which has the highest rate of tuberculosis, the number of infections per 100,000 residents jumped from 7.9 in 2021 to 13.0 in 2022. Hawaii has the second-highest tuberculosis rate, but the rate decreased slightly from 7.4 to 7.0 over the same period. California's rate rose from 4.5 to 4.7, while rates in Texas and New York rose from 3.4 to 3.7 and 3.6, respectively, according to CDC data.

In Texas, local health departments are conducting their own investigation and follow-up, a spokesperson said.

Tommy Camden, tuberculosis prevention and control program manager for the San Antonio Metropolitan Health District, said the agency operates the clinic and partners with local hospitals and the Texas Biomedical Research Institute. San Antonio is one of the few facilities in the United States where he received a 10-year research funding grant from the CDC.

But Camden said San Antonio lacks funding for prevention, treatment and control, including public health staffing. He said he helped the city fund six more positions in the department to make up for state and federal funding gaps.

“It's a big challenge. … There are caps on state and federal aid,” he said. “Funding has remained largely flat, putting a strain on all TB programs, while needs and necessities have increased and challenges have grown.”

In Alaska, advocates and medical experts are calling for more state funding to fight tuberculosis. Brian Lefferts, director of environmental health and technology for the Yukon Kuskokwim Health Corporation, which represents 58 tribes, said the province has contributed about $960,000 through tuberculosis and congenital syphilis prevention grants.

“We still have a very big tuberculosis problem, which is great, but there's always more we can do,” Lefferts said.

More than 530 cases of tuberculosis were confirmed in New York City alone in 2022, according to the state health department.

New York State Department of Health spokeswoman Erin Clary told Stateline that in the event of an outbreak, the state health department works with local health departments to conduct contact tracing, screening and testing. Treatment will be provided to those who test positive for tuberculosis infection.

California health officials provide patient education materials in multiple languages, collaborate with approximately 30 community-based organizations on outbreak prevention, and coordinate with local health departments on outbreak response. He said there was.

Alaska's community testing efforts are focused on areas with the highest infection rates, including Alaska Native communities in the southwest and northern regions of the state. There were 95 cases in the state in 2022, a 64% increase from the previous year, according to a health department report.

Monitoring and screening to catch cases

A vaccine for tuberculosis exists, but it is not recommended for use in the United States because it may interfere with skin sample tuberculosis tests and its effectiveness against pulmonary tuberculosis in adults is questionable. Research is underway to develop a new vaccine.

The disease can be difficult to treat due to antibiotic resistance, which necessitates multidrug therapy.

“Currently, we have so much drug-resistant tuberculosis that we have to treat it very seriously,” says Alison, a family medicine physician and researcher at the Johns Hopkins School of Nursing and Bloomberg University Center for Indigenous Health. Dr. Kelliher says:

A person may have an infection called latent tuberculosis, which is not contagious and shows no symptoms, but can become active and contagious if the immune system cannot stop it. sex may increase.

“[TB] It may be insidious. You might see it differently,” Kelliher said. He pointed out that in addition to pulmonary tuberculosis, there are other types of tuberculosis that affect the bones and kidneys. “Tuberculosis can be a great deceiver.”

Kelliher, a Koyukon-Athabascan from Nome, Alaska, is no stranger to the disease. Her biological grandmother died from the disease, and her other grandmother, who adopted her mother, also had a lung resection due to the disease, she said.

“The impact of tuberculosis is generational and cannot be overstated when you consider this disease and the way it has devastated our population in the past,” she said. “We tend to live close together.”

U.S. territories such as the Marshall Islands, Northern Mariana Islands, and Guam also have high infection rates, with 280.6, 67.8, and 34.4 infections per 100,000 people, respectively, in 2021.

Thibo Alam Shinagawa, senior program manager for infectious diseases at the San Francisco-based Asia Pacific Association of Health Organizations, works on outreach and access to care in mainland Pacific Islander communities. She is also the administrator of the National Tuberculosis Elimination Alliance.

Her group is working with the CDC and community organizations to “break down the stigma around tuberculosis and support the most vulnerable populations, those with the most language barriers, and those in need of culturally relevant and linguistic care.” We engage in educational activities aimed at “connecting people to public health.” department,” Shinagawa said.

According to the CDC, an estimated 13 million people in the United States live with latent tuberculosis, many of whom are unaware they have the disease. Experts say awareness of risk factors is essential so people can get tested and prevent the spread if an outbreak becomes active.

As Congress considers cutting the CDC's budget, Benjamin said he hopes resources are preserved and allocated to the Office of Tuberculosis Control to better support states' efforts.

“We really need a statewide effort to address this,” Benjamin said. “We need to put more emphasis on tuberculosis. It's not that the CDC isn't trying. They need the resources to do it.”

Stateline is part of States Newsroom, a nonprofit news network supported by a coalition of grants and donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact Editor Scott S. Greenberger. [email protected]. Follow Stateline on Facebook twitter.