TB declines in United States, but fight escalates globally

Control efforts are hampered by long treatment regimens and the difficulty of convincing people to be screened after exposure.

By Victoria Stagg Elliott, AMNews staff. April 16, 2001.

When two suburban Chicago residents were recently diagnosed with tuberculosis, James Gallai, MD, executive vice president of field operations of the Suburban Cook County Tuberculosis Sanitarium District, sent in the ground troops. Their mission: to screen the other 1,000 residents of the building where the TB patients lived. Dr. Gallai's organization sent out mailings, set up on-site clinics and laid out donuts to try to attract neighbors' attention.

In the end, only 37 out of 1,000 people showed up. Dr. Gallai's organization has certainly had other, more successful attempts, most commonly in workplaces where the employer requires screening. But this case illustrates one of the biggest difficulties of eliminating TB, he said. People don't think they are at risk.

There are about 20,000 cases of active TB annually in the United States, a number that has been declining about 7% a year since 1992. Another estimated 10 million to 15 million people carry TB, with a 10% lifetime risk of developing the active form of the disease. This risk increases significantly if the immune system is compromised by HIV or other factors.

As in the rest of the country, the number of cases in Chicago declined significantly in 1999, according to statistics released at a March hearing held in honor of World Tuberculosis Day. But, warn public health officials, it also plunged in the 1960s and 1970s, only to reemerge in the late 1980s and early 1990s, spurred on by a lack of efforts to control the disease and the emergence of HIV and AIDS. [...]