
TB Is Now the Top Infectious Killer - cryoshon
http://www.npr.org/sections/goatsandsoda/2015/10/28/452565249/tb-is-now-the-top-infectious-killer-even-though-deaths-are-down
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cryoshon
"There's another TB statistic that's particularly worrisome. The new report
estimates that there were roughly half a million cases of multi-drug-resistant
TB last year, double the number from the year 2000. Conventional antibiotics
can't cure MDR-TB. Treatment can take two years or more with drugs that cause
severe side-effects; some patients are left completely deaf."

I did a semester-long report on TB in college, and our findings were that
multiple drug resistant TB and poly-drug resistant TB would be growing public
health problems in poor countries in the coming decades. This was a
conservative way of framing that problem. Realistically, TB is wildly
infectious, and extremely dangerous to societies that can't afford treatment.

The clinch is that TB is entirely treatable, but it is very money and resource
intensive to do so, requiring reliable access to medication and quarantining
from healthy people over a long period of time. In poor countries, compliance
with single drug regimens isn't great a lot of the time due to nonexistent
infrastructure for distribution and treatment monitoring-- requiring a
cocktail of drugs to deal with drug resistant TB is no different.
Additionally, TB-specific hospitals, where they exist, are largely places that
people with TB go to die. Their relatives frequently get infected from
visiting a TB-infested hospital den, of course.

The rise of XDR-TB (poly drug resistant) means that a growing number of people
get a death sentence from an otherwise treatable disease. The suggestions I
made in my college report were to invest in healthcare infrastructure and
secured involuntary quarantine facilities; the former to help those with MDR-
TB and regular TB, and the latter for the rest, who probably can't be helped
rationally under utilitarian economics of a poor country. Best to limit
exposure to the healthy.

~~~
flatline
Very informative, thank you. With regards to the quarantine facilities, ebola
showed us that this can be a very touchy subject - the Americans/Europeans
swooping in and locking people away. Perhaps the fact that TB is more readily
treatable, and that patients will generally recover, will help the situation.

~~~
cryoshon
Depends, really. During the Ebola scare, the Nigerian government came down
extremely hard with military enforced curfews, public water/transit shutdowns,
involuntary quarantines, etc. Not only did these "harsh" strategies work, they
worked spectacularly at preventing widespread infection.

I highly doubt these measures would be used against TB, though-- it just isn't
deadly enough. The countries with high TB infection rates are the ones without
a serviceable central government.

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touchofevil
I think that the threat of infectious diseases like ebola and TB are among the
main reasons for developed nations to get serious about reducing economic
inequality both globally and within developed countries.

I live in LA and a few years back there were several articles written about TB
spreading within the homeless population. With all the resources that the US
government pays to monitor its population to try to prevent a terrorists from
using things like biological weapons, you would think that the US government
would be concerned about members of the homeless population that are carrying
TB or MDR-TB. The infected homeless are basically untrackable since they most
likely don't have bank accounts, home addresses, etc.

If you told the CIA that you knew of an untraceable terrorist sleeper cell in
the US spreading a contagious disease, you would likely have their full
attention. In some ways this is what's being allowed to happen, even as the US
dumps billions into fighting terrorism abroad.

Working to reduce inequality abroad might also help to stop outbreaks like we
saw with ebola. I think in the future, people will look back and say "Well of
course there was going to be a global pandemic that wiped out X percent of the
world population. You can't have a world that is hyper-connected with air
travel while simultaneously leaving most of the population in poverty without
getting that result."

TB in LA article: [http://www.huffingtonpost.com/2013/02/22/tuberculosis-
outbre...](http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbreak-los-
angeles_n_2743373.html)

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andyjohnson0
Earlier this week the UK media were reporting that some parts of London rates
of TB up to 150 cases per 100,000 population - higher than Iraq, Eritrea and
Rwanda.

[http://www.theguardian.com/society/2015/oct/27/tb-rates-
in-p...](http://www.theguardian.com/society/2015/oct/27/tb-rates-in-parts-of-
london-worse-than-iraq-eritrea-and-rwanda)

~~~
tomjen3
Any particular reason why? London isn't exactly a third world city and the
British have a free healthcare system which should be rich enough to handle
the treatment.

~~~
andyjohnson0
Poverty and inequality.

Some areas (eg Newham) have large minority populations that travel to
countries where TB is common, and are often disengaged from the healthcare
system. Poor (eg damp) housing sustains it.

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riffraff
Am I missing something, or we have had a TB vaccine for almost a century?
Wouldn't that be a "trivial" solution to the problem?

~~~
cryoshon
[https://en.wikipedia.org/wiki/BCG_vaccine](https://en.wikipedia.org/wiki/BCG_vaccine)

That's the vaccine. You can't prevent your way out of an already-blown
epidemic, though. I'm also not sure how common that vaccine is, or for how
long it's protective, or if it's fully protective.

EDIT: all of the information I am wondering about is in the wikipedia article
I linked. Seems like vaccination isn't widespread in a lot of places,
including the US.

~~~
MBCook
Much like Polio, vaccination isn't/wasn't common in the US because it's a
preventable disease that was basically eliminated. I think some higher risk
people may have gotten it (teachers, medical professionals, etc.) but since
the vast majority of people wouldn't ever see TB in person they didn't need
the vaccine.

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MBCook
For anyone interested the PBS Documentary show American Experience had a
fantastic episode on TB a month or two ago called "The Forgotten Plague"
(although they do talk a bit about how it's coming back thanks to drug
resistance at the end).

[http://www.pbs.org/wgbh/americanexperience/films/plague/](http://www.pbs.org/wgbh/americanexperience/films/plague/)

~~~
LandoCalrissian
This was really good, a few things about it really surprised me since my
understanding of the history of TB was pretty lacking. Really recommend
checking it out.

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Dirlewanger
More than malaria...? Article mentions nothing about it.

~~~
gsibble
It may be distinguishing between diseases that are transmittable between
humans and those that are transmitted by a 3rd party (a mosquito).

