Trouble with TB

– Cases of tuberculosis in Santa Clara County have diminished
significantly since an alarming spike in 2002, but the county still
ranks among the worst in the nation in prevalence of the
Gilroy – Cases of tuberculosis in Santa Clara County have diminished significantly since an alarming spike in 2002, but the county still ranks among the worst in the nation in prevalence of the disease.

With 203 cases last year, there was more TB in this county than in 30 states and the District of Colombia. And with a rate of 11.7 cases for every 100,000 people, the county far outstrips the state (8.2) and national (4.9) averages.

Wednesday, health officials said that the county’s TB trouble is largely due to its diverse population. Of all the active TB cases in the country last year, half of them were in people born in other countries, said Janie Burkhart, of the county’s public health department.

“I think the tuberculosis problem in California and the United States is connected to the global epidemic,” Burkhart said. “We live on a much smaller planet than we used to.”

In Santa Clara County, the disease is most prevalent in people from Vietnam, Mexico, India and the Philippines. Last year, all but one of the active cases was diagnosed in North County.

Vivian Smith, spokeswoman for Saint Louise Regional Hospital in Gilroy, said doctors there rarely see the disease. There was just one tubercular patient last year, and there have been none in 2005.

Burkhart said that the technology industry may be to blame for the North County cases because it attracts workers from all over the world.

“We’re a large county and the high-tech industry draws internationally,” she said. “Everything that makes Santa Clara County diverse makes it susceptible to TB.”

Margo Leathers Sidener, executive director of the American Lung Association of Santa Clara-San Benito counties, cautioned that TB is by no means absent in South County. Health officials believe that as many as one in 10 county residents are infected with the virus, which can lie dormant for years.

“There is a potential for it to get out of hand very fast,” she said. “We saw that happen in the early ’90s when we relaxed a little bit and all of a sudden there was a huge increase in TB. One person can infect 50 other people before it is diagnosed.”

In 1988 there were 127 cases in the county. By 1992, 227, and by 1996, 296. The number declined steadily until 2002, when it jumped up to 254 cases.

TB is a contagious airborne disease transmitted through coughing and sneezing. At one time it was the leading cause of the death in the U.S. There were 14,511 reported cases in the U.S. last year, with 60 percent of those in California, Texas, New York, New Jersey, Florida, Georgia and Illinois.

California cases declined by 8.4 percent last year, from 3,227 cases in 2003 to 2,988 cases in 2004. In 1992, there were 5,382 cases.

“This reduction in tuberculosis cases indicates that our statewide prevention programs are working,” State Public Health Officer Dr. Richard J. Jackson said. “Despite the good news, we must not become complacent. California still has more tuberculosis cases than any other state in the nation.”

According to the U.S. Centers for Disease Control and Prevention, one-third of the world’s population is infected with the TB bacterium. Globally, about 8 million people each year contract the disease, and more than 2 million people die.

Deaths in this country are rare, but Sidener said one of the biggest challenges in treating the disease is the stigma it carries as a death sentence in many parts of the world, particularly underdeveloped nations.

“In America, we have the luxury of declining rates,” she said. “When people come from a culture where TB is a stigma, it’s hard to convince them that it can be cured.”

The treatment regimen for TB involves a series of medications and can last from six to nine months, or longer in drug-resistant cases. Burkhart said the county’s declining rate is due in part to extensive outreach efforts by the county and the Tuberculosis Prevention Partnership, which comprises the county health department, the ALA and Asian-Americans for Community Involvement.

“It’s really difficult to attribute it to anything, but we hope its because of our outreach and investigation efforts,” Burkhart said. “Outreach to patients and to medical providers as well..”

Public health nurses are very active in treating people with the disease, going so far as to watch people take their medication, and conducting contact investigations. In the investigations, nurses try to sort out where the person was infected and who they may have infected in turn.

Today, to mark World Stop TB Day, the county will recognize six public health workers as “Diligent Detectives” for their work in containing TB.

“We really do have to be a bit like detectives,” said Public Health Nurse Connie Macias, an honoree. “We follow clues to determine where patients may have gotten or transmitted TB.”

Sidener said that the workers’ jobs have gotten harder in recent years because the state in 2001 cut about $400,000 in annual TB funding. She said that under the federal government’s complex funding system, the county does not receive grants commensurate with its infection rates.

“Treating TB is very expensive,” she said of the time and labor health workers invest. “We’re very concerned about keeping that infrastructure.”

World Stop TB Day commemorates March 24, 1882, when scientist Robert Koch announced his discovery of the disease. Symptoms of TB include fever, coughing, fatigue weight-loss and diminished appetite.

For more information or to find out how to get tested, call the county public health department at 793-6762.

County cases

California counties with the most TB cases

• Los Angeles 931

• San Diego 320

• Orange 224

• Santa Clara 203

• Sacramento 161

• Alameda 144

• San Francisco 133

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