Jessica's Final Paper

Jessica Rix
April 14, 2008
Dr. Rachel Robson
Bioethics

Tuberculosis

Tuberculosis (TB) is a fatal, airborne disease that infects about one-third of the world’s population. Millions of people die from it each year (McKinney, Jacobs, & Bloom 1998). TB rates in the United States are low and it is important that it stays that way. TB rates in recent immigrants are relatively high and that creates a potential hazard to the prevention of the spread of TB. These immigrants are from countries such as those in South and Central America and Asia that have a much higher prevalence for TB than the United States. TB cannot be prevented and is hard to treat. The vaccine that is available for TB does not provide lifelong protection. The treatment for TB also takes a long time of taking daily antibiotics. There can also be complications when the treatment is not taken regularly. The Center for Disease Control (CDC) has a budget for TB treatment and prevention; however, it is significantly low. TB is a serious disease that can become a large problem if nothing is done to control the spread and/or mutation of TB. A higher budget would allow for more research in a better vaccine and therefore better prevention of TB. The United States needs to take TB more seriously and be more active in preventing its spread.

Tuberculosis is a larger problem in developing countries than in the United States. This is because there are fewer opportunities for medical treatments, and a higher prevalence of other diseases, such as HIV (McKinney, Jacobs, & Bloom 1998). About 4.8 per 100,000 people are infected with active TB per year in the United States. This number has declined by about 3.8 percent from 2004 to 2005, according to Morbidity and Mortality Weekly Report (2006). The TB rates in South and Central America and Asia are higher than in the United States. In 2002, cities in Asia like Hong Kong, Malaysia, and Brunei varied between 18-37 TB cases per 100,000 people (WHO 2005). About 277 people out of 100,000 have TB in Mexico (Sánchez-Pérez, Flores-Hernández, Jansá, et.al 2001). In Eastern Europe and Soviet Union regions the rates of TB range from 19 to 80 per 100,000 people from 1990-1992 (Raviglione et al 1994). The global burden on TB is high. In 1997, there were an estimated 7.96 million cases of TB. Of those cases, about 1.87 million people died. There was a fatality rate of 23 percent, but that percent exceeded 50 percent in some African countries. More than half of the TB cases occurred in five southeastern Asian countries (Dye, et al., 1999). These TB rates are significantly higher and become a problem when immigrants from these countries come to the United States.

The concern about TB is a result of the recent percentage of peoples that are either Hispanic or Asian, born not in the U.S., who have immigrated and brought over a higher prevalence and risk of having and spreading TB. In the 1990's Spanish speaking people from Latin America accounted for more than 60 percent of the growth of immigration. People from Mexico increased from 22 percent of immigrants to 30 percent of immigrants between 1990 and 2000. Mexico also accounted for 43 percent of the growth between 1990 and 2000 (Camarota & McArdle 2003). These immigrants bring a higher prevalence for TB into America, heightening the chances of spreading the disease.

The TB rates of people born in foreign countries that live in the United States are higher than the rates of people born in the United States. In 2003 the Hispanic immigrants were responsible for 10.3 cases of TB out of 100,000 people. That decreased very little over two years, and in 2005, there were 9.4 cases of TB out of 100,000 people. The Asian born immigrants account for the most TB cases in both 2003 and 2005. There were 29.6 cases out of 100,000 in 2003 and 25.5 cases out of 100,000 in 2005 (MMWR 2006). Foreign born immigrants had TB 8.7 percent more than people born in America.

Tuberculosis cannot be prevented with the vaccine that is currently available. There is one main vaccination called Bacille Calmette-Gurin (BCG) that is given to people who do not currently have a TB infection. The vaccine does not give lifelong protection and only prevents the person from getting TB for up to fifteen years (MMWR 1996). It is derived from Mycobacterium bovis and weakened to administer to patients. Mary E. Wilson, M.D., was quoted in Journal Watch Infectious Diseases saying, “BCG vaccination is a highly cost-effective intervention against severe childhood tuberculosis in high-incidence countries.” (2006) The BCG vaccine is given in a single dose to a person after a negative PPD test. BCG is used in many countries with a high prevalence of TB. The vaccine helps to control the spread of TB. The vaccine however, interferes with one of the easiest and cheapest ways to test for TB. A PPD, or purified protein derivative, test will determine if patients have TB or not. The use of the BCG vaccine however can cause a positive result in a PPD test. This makes it difficult to say whether or not the person actually has TB or only tests positive because of the vaccine. A more active approach to TB prevention would consider researching new possible vaccinations.

Tuberculosis is a potential problem because of the recent immigrants into the United States. There is relatively, a much higher prevalence of having TB in the immigrants which can lead to the spread and mutation of it in the United States. Tuberculosis is a deadly airborne disease that is difficult to treat. However, the treatment is essential in controlling the spread of TB. Treatment for TB requires taking oral antibiotics for more than six months. There are also side effects such as nausea connected with the treatment. The long duration and side effects of treatment are the reasons why patients may not take their pills regularly. Non-compliance rates are affected most by alcohol abuse and homelessness (Burman, et.al 2007). The infrequent doses of medication in the patient’s body can create complications such as the TB bacteria becoming resistant to the medication (Salyers & Whitt 2005). If the TB bacteria become resistant to the types of medication that are available, then when more people contract the disease it will be even more difficult to cure and keep under control in the United States. This can be a serious problem if an outbreak of TB were to occur. Therefore, the medication given for the treatment of TB needs to be taken regularly for the entire duration of six months or more, until the TB is completely cured.

The CDC, Center for Disease Control, has a budget specifically for tuberculosis. However, the budget only amounts to about 136,700 dollars to 136, 800 dollars. This budget is to cover the entire United States’ tuberculosis costs. It is irresponsible to keep such a low budget until the time comes when we need the money to correct a problem. There should be enough of a budget to prevent such a problem as an increased rate of TB cases in the United States.

Accurately identifying people with tuberculosis is necessary to correctly treat them and stop the spread of TB. There are non-compliance problems with the treatment of TB. Patients are likely to take their drugs carelessly, which would give the opportunity for drug-resistant TB to evolve (Salyers & Whitt 2005). Patients not taking the TB treatment or taking it carelessly would result in more cases of TB that would be harder to get rid of. Therefore, more people would die from TB. Also with an inadequate vaccine and insufficient funding tuberculosis has the potential to become a major problem in the United States. There is a lot that is still unknown about tuberculosis, so the United States needs to be more serious about the threat of TB.

Works Cited

Bloom, B. R., & Murray, C. J. L. (1992). Tuberculosis: Commentary on a Reemergent Killer. Science, 257, 1055-1064.

Borchers, M.D., D. (2000) Tuberculosis Testing and the BCG Vaccine. April 11, 2008. <http://www.fwcc.org/TB_BCG.htm>

Burman, W. J., Cohn, D. L., Rietmeijer, C. A., Judson, F. N., Sbarbaro, J. A., and Reve, R. R. (1997) Noncompliance With Directly Observed Therapy for Tuberculosis: Epidemiology and Effect on the Outcome of Treatment Chest, 111, 1168-1173.

Camarota, S.A., McArdle, N. (2003) Where Immigrants Live. April 11, 2008. <http://www.cis.org/articles/2003/back1203.html>

Ginsberg, A. M. (1998). The Tuberculosis Epidemic. Scientific Challenges and Opportunities. Public Health Report, 113, 128-136.

McKenna M.D. M. P. H., M. T., McCray M. D., E., Onorato M. D., I. (1995) The Epidemiology of Tuberculosis among Foreign-Born Persons in the United States, 1986 to 1993. The New England Journal of Medicine, 332, 1071-1076.

McKinney, J. D., Jacobs, W. R., Jr., & Bloom, B. R. (1998) Persisting Problems in Tuberculosis. In R. M. Krause (Ed.), Emerging Infections (51-183). San Diego, California: Academic Press.

Orme, I. M., PhD (1999) Beyond BCG: the potential for a more effective TB vaccine. Molecular Medicine Today, 5, 487-492.

Pratt, R., Robison, V., Navin, T., Hlavsa, M. (2006). Trends in Tuberculosis —-United States, 2005. Morbidity and Mortality Weekly Report, 55, 305-308

Raviglione, M.C., Rieder, H.L., Styblo, K., Khomenko, A.G., Esteves, K., Kochi, A. (1994). Tuberculosis trends in eastern Europe and the former USSR. Tubercle and Lung Disease, 75, 400-416.

Sánchez-Pérez, Flores-Hernández, Jansá, et.al (2001) Pulmonary tuberculosis and associated factors in areas of high levels of poverty in Chiapas, Mexico. International Journal of Epidemiology, 30, 386-393.

Salyers, A. A., Whitt, D. D. (2002) Bacterial Pathogenesis A molecular Approach. Washington, D. C.: American Society for Microbiology Press.

Salyers, A. A., Whitt, D. D. (2005) Revenge of the Microbes: How Bacterial Resistance Is Undermining the Antibiotic Miracle. Washington, D. C.: American Society for Microbiology Press.

Talbot M.D., E. A., Moore M.D. M.P.H., M., McCray M.D., E., Binkin M.D. M.P.H., N. J. (2000) Tuberculosis Among Foreign-Born Persons in the United States, 1993-1998. The Journal of the American Medical Association, 284, 2894-2900.

World Health Organization. (2005). TB Rising with Ageing Populations in East Asia. April 11, 2008. <http://www.wpro.who.int/media_centre/press_releases/pr_20020219.htm>

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License