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Tuberculosis Control: Think Globally , Act Locally

Tuberculosis Control: Think Globally , Act Locally. Sponsored by: Sen. Richard T. Moore and Rep. Peter J. Koutoujian and American Lung Association of Massachusetts Boston University School of Public Health Massachusetts Infectious Diseases Society Massachusetts Public Health Association

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Tuberculosis Control: Think Globally , Act Locally

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  1. Tuberculosis Control:Think Globally, Act Locally Sponsored by: Sen. Richard T. Moore and Rep. Peter J. Koutoujian and American Lung Association of Massachusetts Boston University School of Public Health Massachusetts Infectious Diseases Society Massachusetts Public Health Association The Medical Advisory Committee to Eliminate Tuberculosis Partners in Health RESULTS

  2. TB-Not Gone, but Forgotten? Tom Garvey, MD, JD Chair, Subcommittee on Government Relations, Medical Advisory Committee to Eliminate Tuberculosis Harvard Clinical Fellow, The Cambridge Hospital

  3. What is Tuberculosis? “The white plague” “Consumption” “The English disease” “Pthisis” “Decay” “The captain of all the men of death”

  4. Transmission

  5. a TB sanitorium in the late 1800s

  6. The End?

  7. Tuberculosis II: Multi-Drug Resistant Tuberculosis

  8. The Cycle of Neglect US Tuberculosis Case Rates by Year

  9. MDR TB 1993-1998

  10. Multidrug-Resistant TB (MDR TB) • Presents difficult treatment problems • Treatment must be individualized • Requires longer courses of more expensive, more toxic, less effective medications • Requires directly observed therapy (DOT) to ensure adherence

  11. Factors Contributing to the Decrease in TB Morbidity Since 1993 Increased efforts to strengthen TB control programs that • Promptly identify persons with TB Identify contacts to persons with infectious TB; evaluate and offer therapy • Test high-risk groups for latent (i.e. not active) TB infection; offer therapy as appropriate • Initiate appropriate treatment • Ensure completion of therapy bydirectly observed therapy(DOT)

  12. Directly Observed Therapy (DOT) Patient observed swallowing each dose of medication Preferred public health practice in therapy of TB Partial treatment of infection selects for drug resistant surviving TB germs. Key to getting patients to take a complicated regimen for 6 months. In countries where anti-TB drugs taken w/o supervision, higher incidence of resistance. Thus, the state needs to support the staff needed for DOT to protect the public health.

  13. Cost of the New York Outbreak • Human costs (incalculable) • Emergence of new, more deadly strains of tuberculosis • Diversion of health resources away from other problems • State monetary: Ten times x cost savings of cutting prevention • Total monetary: >$1 billion

  14. The Trend in Massachusetts • Because of general cuts to public health, local health departments are laying off public health nurses--the eyes and ears of TB control • We have shut down 4 out of 23 Tuberculosis clinics in the last 2 years, most problematically in Framingham and New Bedford, where there are high-risk populations • Proposals have been floated to charge patients for secondary TB tests and TB medications

  15. Conclusions • Tuberculosis continues to be one of the leading threats to human health. • Although it is preventable and curable, relaxation of the effort to fight it has disastrous consequences. • Our TB clinics are an irreplaceable barrier against the epidemic through their concentration of expertise, their TB tracking and outreach resources, and directly observed therapy.

  16. Recommendations: • That no further cuts be made to the Department of Public Health • That a separate line item for tuberculosis clinics be created • That funding for existing clinics be maintained • That the clinics be restarted in Framingham and New Bedford and a new one be founded in Quincy since these are potential breeding grounds for an epidemic • That no barriers, including fees be applied to tuberculosis testing and treatment

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