TB in MD on the UP

Sometimes I hate to be right.

At the end of May, OSHA trashed its proposed standard that would have protected workers against TB. OSHA Director John Henshaw justified OSHA's action by arguing that TB rates had fallen so much that the standard was no longer needed.

An article in today's Washington Post describes "A 17 percent rise in the number of active TB cases in Maryland last year -- with just a slight decline this year" that has put TB "back on the radar for public health officials."

After falling for a decade, the number of people infected with active TB in Maryland jumped from 262 cases in 2001 to 306 last year. This year, 140 cases were recorded through July.

Right now, Maryland public health authorities are practicing Directly Observed Therapy (DOT), sending nurses out to observe patients each time they take their medication. DOT not only increases the cure rate, but more importantly, by making sure patients take the complete course of medicine, prevents the development of antibiotic resistant TB.

Yet as Maryland grapples with a budget crisis, officials said spending for TB control probably would be cut by about $50,000 next year. The state plans to spend $2.28 million for TB control this year, including about $1.4 million in federal money.

"For a disease that we know how to diagnose and treat and prevent, it's ludicrous for the number of cases to be going up in Maryland. It's unacceptable," said Lee B. Reichman , executive director of the National Tuberculosis Center at the New Jersey Medical School, where many specialists have trained.

To repeat what I wrote in early June:

Ditching the TB standard probably could not have come at a worse time. The United States faced a near epidemic of multiple drug resistant TB in the mid-1980's and early 1990s because the public health system in this country let down its guard. According to the IOM:

Complacency led to neglect of basic public health measures including surveillance, contact tracing, outbreak investigations, and case management services to ensure that individuals completed treatments for latent infection and active disease. This neglect helped set the stage for the resurgence of tuberculosis when new circumstances emerged -- including the HIV/AIDS epidemic, the increase in multidrug-resistant disease (largely due to incomplete treatment), and expanded immigration from regions of the world with high rates of tuberculosis.

In hospitals across the country complacency translated into inadequate isolation rooms, ventilation systems that were not maintained, isolation room doors left open, infectious patients left to wander the halls and no training to recognize symptoms in waiting rooms. In correctional institutions the level of knowledge and control measures was virtually non-existent.

Now we may be faced with a new complacency fueled by an "all-clear" message from OSHA, falling national TB rates, and a public health system stressed to the breaking point by new homeland security demands, huge state budget problems and the Bush tax cuts eating up any chance of significant federal assistance.