Cases of tuberculosis on the rise in county

– The county’s Public Health Department is hoping to increase
awareness of tuberculosis prevention in light of a recent increase
in active infection rates in Santa Clara County and pending cuts to
outreach funding.
SAN JOSE – The county’s Public Health Department is hoping to increase awareness of tuberculosis prevention in light of a recent increase in active infection rates in Santa Clara County and pending cuts to outreach funding.

TB, a contagious bacterial disease transmitted through coughing and sneezing, was once the leading cause of death in the United States and is still considered the world’s deadliest infectious disease, killing more people than malaria and HIV/AIDS combined.

After six years of declining rates, tuberculosis rates rose sharply in Santa Clara County last year. The number of cases countywide jumped to 254, a more than 18 percent increase over 2001’s total of 214 cases. Rates have also recently increased statewide and in other Bay Area counties.

“An 18.6 percent increase is cause for concern,” said Dr. Karen Smith of the county’s TB Prevention and Control Program. “We want to increase the public’s awareness and prevent the spread of the disease.”

The recent increase is probably a combination of several factors, Smith said. Because of funding during flush times in the 1990s, public health officials have done well to combat easier cases, and today’s patient population is more difficult to reach. For example, immigrants may be afraid to seek treatment because of fears about government reporting.

Meanwhile, people tend to delay their care more with the loss of jobs and health care in the economic downturn. And, physicians are likely reporting active cases more because of outreach efforts in the medical community, she said.

“All those things mixed together, I think, is what you’re seeing,” Smith said.

California generally accounts for about a third of the nation’s active cases, and Santa Clara County has the third largest caseload in the state. Over 90 percent of the county’s cases originate from people born in other nations where the disease is more prevalent.

Although the majority of adult cases are in the Southeast Asian population, 55 percent of children under age 5 with active TB are of Latino origin. The majority are born in the United States but exposed through family members or visitors who carry TB. Infection rates among Hispanics in general in Santa Clara County are 12 times those of Caucasians.

“Children are at special risk in that community,” Smith said. “Kids are vulnerable.”

Tuberculosis is still a deadly problem in other countries because in many parts of the world there aren’t adequate drugs to treat it, Smith said. The disease also tends to strike immune-compromised people. And if it’s treated in the wrong way or with the wrong drugs, resistant strains can result.

“With treatment we can almost always cure it,” Smith said. “It’s just that in many parts of the world the medication and knowledge of how to treat it isn’t available.”

There are usually one or two deaths linked to TB in Santa Clara County in a given year, but they are usually linked to other conditions or immune system problems.

Symptoms include fever, coughing, fatigue, weight loss and diminished appetite. Although a person must have active TB in order to transmit it to others, each person with a so-called “latent” or nonactive infection has a 5 to 10 percent chance of developing an active case. Once infectious, a person with active TB will on average infect 10 more people.

An estimated 10 percent of county’s residents have latent infections.

“There’s a large pool of potential risk,” Smith said.

The county has named April TB Awareness month and is working on outreach through media events, health fairs and public health nurses. Officials are urging those who feel they’re at risk to get tested and those who test positive to seek treatment even if they don’t show symptoms.

“You should talk to a physician about treatment and killing the germs in your body before they have a chance to make you sick,” Smith said.

The department also wants to clear a misconception in the Latino community that the “BCG” vaccine commonly used in other countries adequately protects against TB: It does not, Smith said.

The county’s TB program is slated to lose half of its operational funding because of budget cuts, but is not currently slated for layoffs. Widespread outreach and education will probably suffer the most, Smith said.

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