The Epidemic That Sneaked Into L.A. : Health authorities face growing TB threat

The World Health Organization recently labeled tuberculosis “the world’s most neglected health crisis.” It had good reason. Deaths worldwide from TB continue to outnumber any other infectious disease, including Acquired Immune Deficiency Syndrome (AIDS). Every year, 3 million people around the globe die from this centuries-old scourge.

NEW SUPER-STRAIN: For a time, the United States was a notable exception. No longer. After a long decline, the disease--which spreads through the air and kills by ravaging the lungs--is rising toward epidemic levels. What’s more, the surge in cases includes a disturbing new element: the emergence of TB strains that resist conventional-treatment drugs.

According to the Centers for Disease Control, TB cases increased by 20% from 1985 to 1992. In 1992, the last year for which statistics were available, the CDC reported 26,673 cases in the United States. That’s a heartbreaking reversal of three decades of steady decline--from more than 84,000 cases in 1953 to a historic low of 22,210 in 1985.

The new outbreak couldn’t come at a worse time for the public health-care system, which, like all too many public institutions, is overburdened and underfunded. In states such as California, deep budget cuts threaten to close clinics that serve primarily the poor and immigrant communities where TB is hitting hardest. In crowded urban areas, the potential for disaster lurks in every new case. In Los Angeles County, for example, the rate of infection is 26 of every 100,000 residents--that’s 2 1/2 times the national average. TB is increasingly seen in those infected with HIV, the homeless and recent immigrants. Despite heroic efforts by health-care and social workers to screen and monitor patients, it is clear that more attention must be paid and more resources devoted to combatting tuberculosis.

A generation ago we quelled TB primarily with then-new drugs. Now, in light of the all-but-incurable new forms of TB, federal, state and local health agencies must do a better job of prevention and early identification of cases while searching for more effective treatments.

NEW MONEY: Doing so begins with funding, even if it doesn’t end there. New money is needed for improved health education, mobile X-ray screening clinics, more programs to induce homeless TB patients to take their medicine, additional public-health workers to track down and monitor infectious people and quicker methods to diagnose the disease.

The federal government must do its share, too. If it can’t stop illegal immigration at the border, then it should help pay the cost--including health costs. About 27% of those with TB are foreign-born. We ought to encourage immigrants, once here, to seek help before they spread the disease further. That means treatment, not punishment, or else victims will have reason to hide their illness.

And finally, we must acknowledge that this is a global disease. If we do not contribute to fighting it abroad, it will surely continue to cross our borders.