Health Officials Call for New Fight on Drug-Resistant Types of TB

Alarmed over widely scattered outbreaks of drug-resistant forms of tuberculosis, nearly 100 federal health officials and private researchers urged Monday that new medications and detection methods be developed to head off the resurgent disease.

In a day-long meeting, the scientists drew up a proposal describing 40 federally sponsored studies they believe would help prevent, diagnose and treat particularly dangerous strains of TB that have struck in 17 states, including California.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said in convening the meeting that “a very imposing problem” could turn into “a catastrophe” unless major steps are taken.

The federal Centers for Disease Control said last month that the spread of TB was out of control, and that it posed a special danger to carriers of HIV, the virus that causes AIDS.

Although tuberculosis was once the most prevalent cause of death in the United States, the development of streptomycin and other antibiotics in the last 50 years had rendered the disease curable or, at least, preventable.

In recent years, new TB strains have not responded to drugs. Scientists are uncertain why, but one theory is that many TB patients stopped using their medication months too soon, and remaining TB bacteria developed resistance to the drug.

In proposing projects aimed at finding answers to the many new questions about the disease, the federal officials and researchers did not address a major obstacle: the availability of funds.

A little more than $5 million in federal funds is being spent this year on 24 research projects. Some of the complex studies proposed could cost more than $20 million each.

President Bush has requested only a small increase in medical research spending for the fiscal year to begin Oct. 1, although he has proposed allocating $80 million--a fourfold increase--to cities and states for TB screening and therapeutic measures.

Fauci would not give an estimate of how much money would be needed for the 40 proposed studies. He said that for now, “we’ll have to move money around” from other programs, take dollars from a reserve fund and lay the groundwork for higher budget requests in the future.

“We are still fighting tuberculosis with diagnostic techniques developed almost a century ago, without new antibiotic therapies and without an effective vaccine to prevent the disease,” he said in a background paper.

At the meeting, officials described outbreaks of drug-resistant TB in New York, where 11 of 13 TB patients in a Queens hospital died and seven infected state prison inmates died. Some hospital workers and prison guards also tested positive for the disease, and one guard died.

Of the TB patients in the hospital outbreak, 85% also were infected with HIV, the human immunodeficiency virus. Their weakened immune systems allowed the rapid progress of TB from the latent to active stage.

The TB bacterium can be transmitted in droplets dispersed through the air by coughing. Officials say that the risk of catching it rises only in close and prolonged contact with a sick person, but one of the mysteries of TB is why some people seem to spread the germ more easily than others. Another is why some people may be more susceptible to TB than others.

TB symptoms include a cough, fever, night sweats, fatigue, weight loss and blood-tinged sputum.