(Circulation. 2000;101:e9038.)
© 2000 American Heart Association, Inc.
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Global Tuberculosis Threat Demands US Response
It took the United States 7 years and several billion dollars to overcome the resurgence of tuberculosis (TB) that occurred in the 1980s. Yet most people do not realize that the disease’s resurgence was the result of federal inactivity after Congress eliminated TB prevention funds in 1972.
Now that new cases of the disease are at an all-time low in the United States, infectious disease experts warn that the disease could resurface if the nation does not take decisive steps to identify and treat undetected TB cases. In its report, Ending Neglect: The Elimination of Tuberculosis in the United States, the Institute of Medicine proposes a multistep strategy to eliminate TB in the United States by the year 2035.
"Despite the falling number of cases in the United States, this country has entered a dangerous phase in which the disease has retreated to specific communities where it can lie dormant and resist detection," said Morton N. Swartz, MD, chairman of the Committee on the Elimination of Tuberculosis in the United States, during a telephone conference on the report. "Without decisive steps to identify and treat the undetected cases, the disease could come back with a vengeance and exact a heavy price. US policy-makers cannot afford to relax their vigilance. Current efforts at TB control will not be sufficient, and doing less could be disastrous."
The report recommends an aggressive approach to solving the problem, including the following:
- Improving screening for latent infections among high-risk groups
- Reorganizing TB control efforts to reflect the changing incidence of the disease.
- Increasing US efforts to assist other countries in fighting the epidemic
- Bolstering research into better methods for treating and detecting latent infections
- Reorganizing TB control efforts to reflect the changing incidence of the disease.
Potential immigrants from countries where the disease is prevalent are among the high-risk groups to be screened more aggressively for latent infections, said Dr Swartz. Currently, immigrants are screened for active, contagious cases of TB. However, under the new recommendations, all visa applicants for permanent residency who are from countries of high incidence would be asked to get a tuberculin skin test before entering the United States. Documents granting permanent residency would be withheld until the immigrants received the needed screening or treatment after arrival in the United States.
"While this may sound simple, it would require both a major shift in the current immigrant program and additional funding from Congress. We estimate the cost at $23 million, although in the long run, this would be cheaper than the cost of treating the individuals and others they infect," said Dr Swartz.
Because the risk of a person with latent infection transmitting the disease is lower when that person is in the United States on a temporary visa, it would be difficult to prove that this is necessary. For that reason, the committee encourages employers and schools to consider providing treatment and screening for workers and students in the country on temporary visas.
At this time, 
7 million foreign-born people with latent TB
infections live in the United States; however, the committee did not
call for mandatory screening and treatment of individuals in this
category. Instead, extended outreach to these groups is needed.
Dr Swartz said mandatory skin tests and treatment are needed for other high-risk groups, such as those in correctional facilities. Transmission of the disease is easy in such confined the conditions.
Although these recommendations could cause fear, they are needed to stop TB once and for all in the United States. "It would be prudent, however, to take the steps that can help prevent future outbreaks," said Dr Swartz. He called on the federal government to triple its investment in TB research to at least $280 million a year to develop better diagnostic tests and treatments. Among needed research is the development of a vaccine to prevent the disease.
At this time, TB control efforts have been centered in local public health departments. However, in some areas, the numbers of TB cases have declined dramatically. In those areas, the TB efforts should be regionalized so that personnel and funds can be used most efficiently.
A constant source of TB infection is the rest of the world, where TB claims 2 to 3 million lives annually. The problem is greatest in the Third World, which has the least resources to fight the disease. The United States should contribute to these efforts, both for its own TB eradication efforts and to aid countries where the disease wreaks havoc.
National Library of Medicine Adds More Drug Information to Consumer Website
Information about >9000 brand name and generic prescription and over-the-counter drugs is now available through the National Library of Medicine’s consumer health website, MEDLINEplus (http://medlineplus.gov). The information includes data on side effects, drug interactions, dosing, precautions, and storage.
The information is provided on the website through a special arrangement with the United States Pharmacopeia (USP), which is located in Rockville, Maryland, according to information provided by the National Library of Medicine. In fact, the website makes available to the public the USP’s Advice for the Patient.
Other information on the website includes resources on diseases, fitness, and nutrition. It also provides links to medical dictionaries, lists of doctors and hospitals, and the adam.com Medical Encyclopedia.
Public Genome Effort Launches Final Phase
The Human Genome Project international consortium has announced the official launch of the final phase of its project to decipher the 3 billion base pairs that serve as a cellular blueprint for the human body. By announcing that it is beginning the final phase, the public group heralds the fact it is transitioning from its attempt to make a working draft of the genome to producing the complete, "finished" sequence.
The 16 centers around the world that make up the project officially
began this phase on May 9. Phase I, which was launched in March 1999,
has resulted in the sequencing of most of the genome in 14 months at a
cost of $300 million. The DNA that remains to be sequenced is
already in the pipeline at the various centers around the world and
will flow into public databases over the next 6 weeks.
Phase II will produce a finished sequence with no gaps, increasing the overall accuracy of the sequence to 99.9%. Phase I produced a "working draft" sequence that had some gaps, although it allowed scientists to identify most human genes directly.
"The goal of Human Genome Sequencing is to provide a solid foundation for the next century of biomedical research," said Richard Gibbs, PhD, director of the Baylor College of Medicine Sequencing Center in Houston, Texas. "We won’t stop until every uncertainty that can be resolved is resolved."
In April, President Bill Clinton and Prime Minister Tony Blair of Britain announced that they intended to follow the advice of their scientists and make the information from the sequencing effort public. A biotechnology company, Celera, has been racing the public effort to complete the sequencing.
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