Resurgence of Tuberculosis Called a Worldwide Crisis

Tuberculosis will strike 90 million people this decade and will kill 30 million if worldwide efforts against it don’t improve, researchers predict.

“The magnitude of the global tuberculosis problem is enormous,” the researchers wrote in a recent issue of the Journal of the American Medical Assn.

Ninety-five percent of cases are in developing countries. The disease is gaining fastest in the Western Pacific and Southeast Asia, where two-thirds of infected people live, said the authors, led by Dr. Mario C. Raviglione of the World Health Organization in Geneva.

Tuberculosis cases worldwide can be expected to increase to 8.8 million this year and to 10.2 million by the year 2000. More than 7.5 million cases occurred in 1990.

Assuming that treatment programs remain at their 1990 effectiveness level, 3 million tuberculosis deaths can be expected this year, and 3.5 million deaths can be expected annually by the year 2000, the authors said. More than 2.5 million died in 1990.

“Without recognition of the tuberculosis crisis confronting the world and prompt, effective action, the tuberculosis epidemic can be expected to worsen,” they said.

TB was on the decline until 1985, when a worldwide resurgence began.

Several factors are to blame, they said. Children born decades ago in areas of high population growth are reaching ages where rates of TB sickness and death are great. Also, famine, war and natural disasters are creating large groups of displaced, malnourished people in crowded conditions that foster the spread of TB. And the AIDS virus is spreading, adding to the vulnerable population.

In 1990, 4.2% of all tuberculosis cases were associated with the AIDS virus, HIV. In the year 2000, an estimated 13.8% of all TB cases may be HIV-associated, the researchers said.

The WHO in April, 1993, declared tuberculosis a global health emergency.

“It hasn’t changed a great deal,” said Dr. Dixie E. Snider Jr. of the U.S. Centers for Disease Control and Prevention, a co-author of the report.

The researchers culled data from ministries of health in various countries, from WHO questionnaires, from respiratory-disease associations and from published literature.

Tuberculosis is spread when an infected person coughs or sneezes bacteria-laden water droplets into the air, which someone else inhales.

Antibiotics can cure the disease, but they must be taken daily for months, and an incomplete course of treatment can produce drug-resistant disease.

The WHO and CDC recommend a five-pronged approach to treating the epidemic: getting governments to commit themselves to effective programs, testing more people, supervising treatment to ensure that patients take all their medicine, establishing a reliable antibiotic supply and monitoring TB control programs to be sure they work.

“It doesn’t cost a whole lot to deal with the problem, at least to keep people from dying, but it’s beyond the investment some of the poorest countries can make,” Snider said.

“It would be wise for the United States to . . . assist other countries in TB control,” he said. “It’s not only the humanitarian thing to do, but the economically wise thing to do, because those people will be consumers of American products rather than dead people.”

The American Lung Assn. agreed, for an added reason: “More than one-fourth of tuberculosis cases in the United States occur in foreign-born individuals. If the disease continues to rage elsewhere in the world, its devastating impact eventually will cross our borders.”