Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, March 29, 1992 TAG: 9203270357
SECTION: EXTRA PAGE: E-1 EDITION: METRO
SOURCE: CHRIS GLADDEN STAFF WRITER
DATELINE: LENGTH: Medium
But the recent outbreaks that are grabbing headlines are different. They're reflective of the 1990s.
"What's different about these outbreaks," Dooley says, "are that they're large and explosive and in institutional settings." Homeless shelters, prisons and health-care facilities are seeing major outbreaks. And many of the people attacked in these settings are HIV-infected, Dooley says.
Tuberculosis is caused by a bacterium, and in many cases the germs are isolated and enclosed by the body's defenses. Many persons can harbor tuberculosis without developing an incapacitating form of the disease.
But AIDS-infected victims stand little chance of battling the drug without treatment; and treatment is more difficult in these patients.
"People with a normal immune system have an 8 to 10 percent chance of developing active TB if they become infected," Dooley says. "There's almost a 40 percent chance if they're HIV-infected.
"Of 29 HIV-infected people exposed in an outbreak in San Francisco, 12 developed active TB in a four-month period," Dooley says.
Complicating matters further is a multidrug-resistant form of TB. There has been drug-resistant TB since drugs were developed, Dooley says. But this strain is resistant not to just one drug but to several. It occurs when drug treatments aren't followed carefully. Sometimes, the drugs are prescribed improperly; other times, the patients don't comply by taking the drugs as prescribed. When this happens, patients can develop a resistance to several drugs and infect others with drug-resistant TB.
In regular tuberculosis, the cure rate is as high as 95 percent if it's diagnosed, Dooley says.
In the multidrug-resistant form, it's in the 50 percent to 60 percent range, and it takes much longer to cure.
"Multidrug-resistant TB takes from at least 18 to 24 months - if you can treat it at all," Dooley says.
The incidence of tuberculosis declined about 5 percent to 6 percent a year from 1953 to 1984. The decline then leveled out - until 1988, when the disease began its comeback. The number of cases increased by more than 5 percent in 1990.
"TB is on the rise," Dooley says. In 1990, there were more than 25,000 cases in the United States, and it remains a worldwide killer claiming 3 million deaths a year.
So far, the worst outbreaks have been in New York and Florida - where there are large concentrations of homeless and AIDS victims.
"All it takes for an outbreak is one person who gets into an institution," Dooley says.
So far, the multidrug-resistant form has not been a real problem in Roanoke, says Lex Gibson, an epidemiology consultant with Virginia's Bureau of Tuberculosis Control. Gibson monitors a territory from far Southwest Virginia to Virginia Beach, and he says he has seen only two cases recently. One victim had to have a lung removed, and the other had to undergo chemotherapy treatment.
Gibson's agency has shrunk in the 16 years he's been with the bureau from a staff of 30 to seven, reflecting the decline in tuberculosis deaths.
"I don't know how much longer that's going to last," he says.
A migratory population can spread the disease from high-incident areas like New York and Florida to places like Roanoke, Gibson says.
"It could get scary."
Meanwhile, medical experts are thinking about a return to the sanitoriums of old.
"TB can be treated anywhere," Gibson says. "The talk now is of using the [sanatorium] to control the spread of the disease."
by CNB