Wednesday, June 8, 2005

A multidrug-resistant tuberculosis known as MDR-TB is persistent in California, primarily among its “foreign-born” population, and has serious financial implications for the state’s public-health system, federal and state health officials said yesterday.

“Treatment for MDR-TB is very expensive — ranging from $200,000 to $1.2 million per person, over an 18- to 24-month time period,” said Dr. Reuben Granich, a lead investigator for the Centers for Disease Control and Prevention, during a press conference in the District yesterday.

Dr. Granich’s findings were published yesterday in tomorrow’s issue of the Journal of the American Medical Association (JAMA) in an article co-written with California health officials.

The article studied 38,291 reported tuberculosis cases in California from 1994 to 2003. Of those, 407 were classified as drug-resistant and were found mostly in patients from Mexico or the Philippines, Dr. Granich said.

He added that 84 percent of patients infected with MDR-TB “were foreign born” and that those infected are four times as likely to die from the disease and twice as likely to “transmit the disease to others” than other tuberculosis patients.

The study did not categorize the “foreign-born” patients as illegal aliens, but says the patients in question characteristically did not complete standard TB treatment and were in the U.S. less than five years at the time of diagnosis. Dr. Granich said multidrug-resistant TB was not associated with homelessness, incarceration, HIV/AIDS or using injected drugs.

And he said its presence does not warrant closing U.S. borders.

“TB is a deadly airborne disease and a global public-health emergency. If we hope to accelerate progress and guard against resurgence of TB, we must employ innovative public-health strategies — not border closings,” Dr. Granich said.

Evidence of drug-resistant TB surfaced in 38 of 61 California health jurisdictions and could “threaten the efficacy of TB control efforts,” the study states, noting that an increasingly larger number of cases were turning up in rural or small-scale health facilities with limited resources.

The situation could add to California’s financial burdens — along with other states with a burgeoning immigrant population. States must honor the 1985 federal law guaranteeing emergency care regardless of citizenship or finances.

A study from the U.S.-Mexico Border Counties Coalition, for example, found that the four states bordering Mexico are still owed more than $200 million in costs from the emergency treatment and transport of ailing or injured illegals.

Cases of tuberculosis, which plateaued in the U.S. after increasing 20 percent in the past two decades, mostly affects the lungs and is spread through airborne bacteria, often through a cough or sneeze. It is considered a global problem, carried in latent form by 2 billion people, or a third of the world’s population, said JAMA editor Dr. Catherine De Angelis.

“Most Americans think TB has been eradicated. If you believe that, then I have a bridge I can sell you,” she said.

In the U.S., almost 15,000 cases were reported last year, with 53 percent of those cases found in foreign-born people. The figure was 29 percent in 1993, according to the study.

The disease has changed throughout history in America. In the 1980s and ‘90s, TB cases in the U.S. increased by 20 percent, fueled primarily by the AIDS epidemic, immigration and fewer services to patients, researchers said. Thanks to renewed emphasis on TB control, the trend has since reversed — but not substantially. In 2003, the number of cases was only down by 1 percent from the previous year.

Although the number of overall TB cases in the state declined by a third in those years, the drug-resistant cases “did not significantly change over the study period,” according to the study, published in a special JAMA issue devoted to various aspects of TB worldwide.

“That has caused us concern,” Dr. Granich said.

Overall, he said, the study underscores the need for better control of TB worldwide and the expansion of overseas screening programs.

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