Posted on 03/18/2007 7:41:34 AM PDT by SwinneySwitch
Success against tuberculosis — a storied disease that afflicted ancient Egyptians and Romantic poets and killed gambler Doc Holliday and first lady Eleanor Roosevelt — has stalled in San Antonio and across the state.
The region's proximity to Mexico is one reason, experts say. But it comes as government support to local TB programs has been cut, bond money to rebuild the state's only TB hospital — the Texas Center for Infectious Disease in San Antonio — has languished in red tape for a decade, and particularly deadly drug-resistant strains have spread through Africa, Russia and China.
After falling steadily for many years, TB cases in Bexar County began heading the other direction three years ago. The latest numbers released by the Metropolitan Health District last week show that 91 Bexar County residents were infected with TB in 2006 — up from an all-time low of 55 cases in 2003.
Across Texas, TB cases have been more or less flat — up one year, down the next — since the beginning of the decade.
Contrast that to the United States as a whole, which has seen a steady decline in cases for 13 years, to 14,097 — an all-time low — in 2005, the most recent year available.
Though 91 cases might not seem like a lot, TB is not like other diseases. It often smolders among society's underclasses, who sometimes vanish before they complete the required six- to nine-month treatment for an uncomplicated case — unwittingly becoming human incubators of drug-resistant strains they then pass on to others.
"It is scary stuff," said Jim Elkins, director of the Texas Center for Infectious Disease, on the Southeast Side. "The thing that one has to realize is that when the words 'multidrug-resistant TB' enter a sentence, we're dealing with 24 months of care, and the data shows about a quarter of a million dollars worth of service."
Each day, caseworkers travel to homes and workplaces to witness TB patients swallow handfuls of pills. Patients who refuse to comply are brought before a judge and ordered quarantined — in extreme cases for as long as two years — at the state-run TCID.
And many, many more — no one really knows how many — have a latent infection lying dormant in their lungs, awaiting only a breach in their immune system from diabetes or cancer treatment or simply old age to become active and contagious to others.
Months of waiting
Dennis Collins is a patient man. In Corpus Christi, his last job was working as a night watchman. But for most of his adult life he simply drifted from town to town, expecting little, enjoying the landscape, and sleeping and eating where he could.
"It was fun when I started," said Collins, 43. "But not any longer. I've had some rough times, but I've also had a lot of good times. I've seen a lot of beautiful places in this country."
At the TCID, where he's been hospitalized since early December, he fills the empty hours making religious crosses from palm leaves in the crafts room, taking part in an alcohol recovery group and crossing Southeast Military Drive a couple of times a day to smoke a cigarette against doctors' advice.
Shortly before Halloween, he became ill and went to a public clinic. "I couldn't eat. I couldn't breathe, actually. I could make it maybe distance-wise a quarter of a block and I would have to sit down."
He was sent to TCID, at which he would have a stable home for several months. After a few weeks' treatment, he was no longer contagious and was moved from an isolation unit to a room he shares with two other patients. It is not, he admits, a bad life.
"The staff is really courteous," he said. "And they have showers."
When most states closed their TB hospitals after the arrival of antibiotics more than 50 years ago, Texas was one of the few that didn't. After the AIDS epidemic in the 1980s sent TB rates skyward again, it proved to be the right decision.
Much of TCID — long known as the San Antonio State Chest Hospital — was built in the early 1950s. When its deteriorating condition threatened its accreditation, the Legislature agreed to rebuild it. About $20 million in revenue bonds for that purpose was approved in 2001, a groundbreaking ceremony was held in 2002 and a wrecking ball was put to one ward in 2003.
Then everything stopped. Some lawmakers tried to get the hospital moved. When those efforts failed, plans were drawn and redrawn. Construction costs rose. Authorization to spend the bond money currently is awaiting legislative approval in the Texas Department of State Health Services budget request.
Although it has 72 beds, the hospital can accommodate only about 55 patients because of its configuration. Contagious patients must be isolated, and only 17 isolation rooms exist. Plans for a new hospital would allow for 75 private rooms.
Despite its problems, the federal government two years ago named TCID and its academic partner, the University of Texas Health Center at Tyler, one of eight Heartland National TB Centers, providing training, referral and research to health professionals and hospitals across the country. The money is for programs. The hospital itself gets none.
'Put a mask on'
The modern battle against tuberculosis, which is caused by rod-shaped bacteria, often begins in a low-tech booth in the city's TB clinic on the northern edge of downtown.
As a plastic egg timer winds down, a simple nebulizer inside the booth emits moist, salty vapors that irritate the lungs. Patients then cough up their contents into a plastic specimen tube. Overhead, a powerful ultraviolet light irradiates any infected droplets that might linger in the air, rendering them harmless.
A box fan in the wall draws the treated air out of the building. Thirty-five minutes pass on the egg timer before the room is considered safe to enter.
It's not undue caution. With no good vaccine for TB, Metropolitan Health District workers are tested every three months for infection. In past years, a few have come up positive.
"In other places, prior to their diagnosis, they're just coughing and spreading it," said Dr. John Nava, the clinic's physician. "If we have a TB suspect walk in here, people from the receptionist all the way up to me with different levels of training say 'OK, you've got to put a mask on.'"
If a patient tests positive, he or she begins treatment with four antibiotics. The medication is free to the patient. Depending on the strain of TB, the number of medicines and the dosage will be adjusted according to the patient's progress.
Since 2003, the year Bexar County's cases bottomed out, state and federal support to the city's $736,000 TB program was cut by $15,172 from the state and $21,224 from the federal government, to $184,272 and $333,476 respectively.
During that time, TB cases have risen here. Specially trained contact investigators have traced several large scares, including one at Somerset Junior High School last year in which 150 students, teachers and staff were tested.
In 2005, seven local patients were resistant to one drug and one to five drugs. However, none fit the precise definition of multidrug-resistant TB, which requires resistance to two specific front-line drugs.
"They're very busy, and they've got very complicated cases," said Dr. Barbara Seaworth, a veteran TB physician at TCID.
Seaworth, who as the Heartland Center director advises doctors across the United States and in Mexico, worries about multiple-drug-resistant strains and the XDR — extensively drug-resistant — TB now found on three continents. Resistant to most first- and second-line drugs, the disease has proven particularly deadly.
"Luckily, we haven't had much of that (XDR) imported to the U.S. yet. There are a few cases that have been imported, but not too many. With being an open society, we're certainly open to that importation of cases."
Mexico is another story. A 2005 study in the New England Journal of Medicine estimated that if the United States spent $35 million to strengthen Mexico's TB programs, it would result in 2,591 fewer U.S. cases and 349 fewer deaths.
"Traditionally, our disease has been more U.S.-born than foreign-born, but I think we do have a lot of movement of individuals across the border. We see increasing numbers of foreign-born patients. We see the epidemiology of TB in Texas every year, more and more of the cases are foreign-born. We're almost at the 50-50 mark now. We'll get there shortly."
Cases for quarantine
Dr. Sandra Guerra-Cantu, the regional medical director for the Texas Department of State Health Services, is not looking forward to a coming trip to Del Rio. Neither the city nor county attorney there is much interested in asking a judge to quarantine an elderly TB patient, as she's requested. She's going to try to convince them.
The man's family discourages him from taking his TB medicine, she explains, complaining that the side effects of treatment are worse than the disease.
"He gets to go to every quinceañera, every birthday party, because they don't think his TB will hurt anyone," Guerra-Cantu said, shaking her head. "They view his health care as optional."
Contrast that case with another recent quarantine to TCID, she said, a Kerrville man whose frightened family basically confined him to a trailer and left groceries outside the door. He was an alcoholic and couldn't cook for himself. His poor nutrition further weakened his immune system, leaving him vulnerable to the TB.
"Sometimes I stress over taking someone's civil liberties away," Guerra-Cantu said. "But my priority as a public health authority is the public. That's why I ask myself, 'Do I feel I can sit my 6-year-old next to him on a bus?' If I can't say yes, I need to do something."
"There's no personal autonomy in TB — you have to watch me take my TB medication," she added. "It's not like a court of law. You're guilty until proven innocent."
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dfinley@express-news.net
PSA ping!
If you want on, or off this S. Texas/Mexico ping list, please FReepMail me.
"Family values don't stop at the Rio Grande". Isn't that one of the favorites of the supporters of the illegals? I guess infectious diseases don't stop there either. I truly wish I could see some will for us to stop importing our own destruction. How many immigrants were sent back from Ellis Island because they carried contagious diseases? We are insane.
Drink Goat's Milk!
The ole wive's tale is it makes you immune from TB.
Nothing wrong with an holistic approach.
Thank you Mexico and Central America - you are sending your "best and brightest" TB carrier North. WE really do appreciate it.
And to GW Bush - this time, you DO earn some of the blame.
Bump
Border and immigration enforcement keeps a whole lot more than people out.
Open borders = disease and pestilance.
I always had to have shots to go out of America. When returning I could not bring produce back because of plant disease and insects.
And now millions of illegals have poured across our borders bringing potential sickness and suffering to Americans who have taken the precautions of immunization seriously. That was until the Bush administration brigade of "migrants" was given the "welcome" light.
And common sense has gone out the window.
Come on, now. They're only spreading the infectious diseases that Americans can't be bothered to spread.
Would a guest worker program, where we could actually test for disease, make you happy ? NOOOOOO. You want an Israeli wall.
Just who are YOU to tell me what I want? What other nation on earth doesn't control its immigration? Some politicians want to go on about how impossible it would be to do anything about the tens of millions already here and in the next sentence tell me how they could easily keep records on the proposed "guest worker" program. Sorry, but that does not compute.
Ellis Island immigrants were isolated and turned back if they had TB..
But the first act my Ellis Island ancestors did when they arrived in the USA was to "kiss the ground".
When Illegals sneak across our borders on foot, the first act they commit on American soil is to "pee on it"..
Disgusting.
sw
A much more valid argument, than those on the Left, for the impeachment of Bush.
I think a lot of people are skeptical about a guest worker program because they are convinced that it would be more than that -- it would almost instantly evolve into a scheme to give people citizenship, welfare, and voting rights. Any talk about screening third world peasants for TB would be condemned as a violation of their "civil rights." We will be treated to propaganda that says that TB really isn't that harmful and we don't really know where TB comes from so we might as well accept it as a ressonable cost for "diversity." Remember how politicized AIDS has become -- the same would happen with TB.
Better yet may the antibiotic resistant and mutated strains spread among the House,Senate, Executive branch and Federal Court system.
My 22 year old daughter tested TB positive and is on treatment.We had to be tested. A friend of mine has a 12 year old that tested positive, and is on treatment. Enjoy the "Diverse Ones!"
My wife was a school nurse in the 1990s and having immigrant students with positive TB tests was not uncommon. In neighboring school district one of these students had active TB and forced dozens of kids and a few teachers to have a year of anti-TB medication. At the time these students were refugees from the Balkan states. I am sure with more immigrants particularly illegal ones coming from countries where TB is endemic this problem is even worse today.
Read all about it at:
http://www.orthoclinical.com/chagas/?gclid=CN7Zyfjj_ooCFU9FGAod1RmVKQ
The region's proximity to Mexico is one reason, experts say.
There, those two sentences belong closer together.
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