Turberculosis
Jan 17, 2002 10:52 AM
TB IN THE COMMUNITY
Q: I THOUGHT TB WAS NO LONGER A BIG PROBLEM. WHY IS THERE AN EPIDEMIC?
A: It's true that TB--once a major killer--had been brought largely under control by antibiotics developed in the 1940s and by improvements in nutrition, living conditions and medical care for the population as a whole. The new epidemic results from several factors, including a decline in public funding for tuberculosis control programs in the 1970s and 1980s. In addition, more than a decade of homelessness, drug abuse and AIDS has left a large population unable to fight off the TB germs.
Q: HOW PREVALENT IS TB?
A: The number of cases in New York City increased dramatically between 1978, when there were only 1,307 reported cases (an all-time low), and 1992, when there were 3,811. With 52 cases per 100,000 people in 1992, New York City's incidence rate was five times the national average.
In 1993, the number of new cases in New York City fell by 15 percent, but it is not yet clear if this means that aggressive action by the city Health Department to control the epidemic has started to have an effect.
Q: I'VE HEARD THE TERM "MULTIPLE DRUG RESISTANT TUBERCULOSIS." WHAT IS THIS?
A: Multiple drug resistant TB (MDR-TB) refers to TB germs that are resistant to two or more of the medications that are most often used to treat the disease. "Resistance" means the medications don't work. If doctors can't find other medicines that do, the patient probably will die.
Public health officials are worried because the number of MDR-TB cases has been growing, particularly among the homeless and prison populations.
Q: HOW DO DRUG-RESISTANT TB BACTERIA ARISE?
A: Drug resistant TB germs develop when TB patients don't complete the full course of their medical treatment, which usually requires taking antibiotics for six to twelve months. A full course of medication kills all of the bacteria, but too little medicine simply promotes the growth of germs that resist the drugs. People often stop taking medicine because they feel better. For those without homes or regular doctors, the obstacles to completing treatment are particularly great.
Q: DO THOSE INFECTED WITH DRUG-RESISTANT TB POSE A PARTICULAR THREAT TO THE HEALTH OF OTHERS?
A: Yes. People who develop active MDR-TB by failing to take all of their medication can endanger other people by infecting them with drug resistant TB germs.
Q: DOES THE EPIDEMIC MEAN I SHOULD BE WORRIED ABOUT CONTRACTING TB IN THE SUBWAY, LIBRARIES, MOVIE THEATERS OR OTHER PUBLIC PLACES I VISIT?
A: No. It would be extremely unlikely to catch TB in such circumstances. As we said earlier, TB infection usually is the result of extended, close contact such as the type that you have with family members.
Q: STUDENTS, TEACHERS, PARAPROFESSIONALS AND OTHER UFT MEMBERS SPEND HOURS TOGETHER IN CLOSE QUARTERS DAY AFTER DAY. DOES THAT POSE A RISK?
A: Although there have been isolated TB outbreaks in schools--most recently in southern California--based on practical experience public health professionals do not consider schools a high-risk setting for catching TB. In New York City, there has been a limited number of cases where a school employee or student was diagnosed with active TB. But when the Department of Health investigated, it determined that no one else in the school community had caught the disease from the infected individual.
Young children with active TB usually are not contagious to other children or adults. This is because young children don't develop the classic TB cough and don't expel TB bacteria into the air as adults do. Schoolchildren could catch TB from a school employee with active TB, but most children who develop TB contract it from family members.
Q: IS IT ANY DIFFERENT IN SECONDARY SCHOOLS?
A: In junior and senior high schools, the situation is different in one way. Teenagers with active TB generally have the adult form of the disease and could transmit it to students and staff. However, even in junior and senior high schools, the risk of catching TB from a student is relatively limited because young people don't develop TB as frequently as adults do. In 1992, adults 35 to 44 years of age--the hardest hit age group in the city--were seven times more likely to have TB than young people in the 15-19 year age group and nearly 18 times more likely to have TB than those in the 10-14 year age group.
Q: I HAVE HEARD THAT CHILDREN WHO RECENTLY IMMIGRATED TO NEW YORK CITY FROM COUNTRIES WITH HIGH RATES OF TB MAY BE CARRIERS OF THE DISEASE. DO THESE YOUNGSTERS POSE A SPECIAL RISK TO OTHER STUDENTS AND SCHOOL EMPLOYEES?
A: It is true that some countries have TB rates much higher than New York City's. As a result, children emigrating from those countries may have been infected with TB germs, but the vast majority do NOT have active cases of TB and do NOT pose a threat to classmates or school employees. In addition, some immigrant children have had the Bacillus Calmette-Guerin (BCG) vaccine for TB, which is popular in other countries but is not used in the United States because its effectiveness has not been proven. BCG recipients may test positive for TB as a result of the vaccine, even though they have never been infected and don't carry the germs in their bodies.
Q: WHAT IF THERE IS CONCERN ABOUT A SUSPECTED CASE OF TB IN MY SCHOOL?
A: Any UFT member who is worried about a possible case of TB should notify the chapter leader who, in turn, will contact the UFT district representative. The UFT Health and Safety Committee, which works in cooperation with consulting industrial hygienists and occupational physicians, will evaluate the situation and provide expert assistance.
Q: WHAT IF STAFF AT OUR SCHOOL WANT MORE INFORMATION ABOUT TB?
A: The UFT provides training about TB for chapter leaders and can arrange educational workshops about TB.
The Bureau of Tuberculosis Control at the New York City Department of Health (212/788-4155) can answer specific questions about TB. It also distributes a number of pamphlets.
