Miami Herald - March 21, 2007

With so many immigrants from the Caribbean and other places where tuberculosis is common, South Florida already is a hot spot for the disease. That puts us at risk for this tough to treat TB strain, too.

Fund global plans

Public-health experts are calling for more funding -- and Congress should listen. The United States should fund global plans to contain the spread of this TB strain, particularly in Africa where it already is a health emergency. There also should be a U.S. plan and funds to stop lethal tuberculosis at home.

Officially called ''extensively drug-resistant tuberculosis,'' the strain is immune to most first- and second-line TB drugs, which makes it extremely difficult to cure. It also is man-made, the result of inadequate TB treatment. Patients who don't finish their full course of antibiotics develop resistant TB strains and can pass them on. An outbreak in South Africa last year illustrates the alarm: 52 of 53 patients, all also HIV positive, were killed by the disease within four weeks.

Now the strain has been found in all South African provinces, and public-health experts say the disease likely has spread to neighboring countries. The threat is not limited to Africa or to people with HIV. This TB strain has been found in 28 countries, including the United States. Experts also suspect the strain may be as contagious as regular tuberculosis, which spreads by air when infected patients cough.

Ironically, the new threat comes at a time when tuberculosis infections have been declining in the United States and Florida. Yet cutting tuberculosis-control programs would be a mistake. After the United States neglected TB programs in the 1970s and 1980s, TB cases began to climb in the late 1980s. In the early 1990s, 300 New Yorkers were infected by a drug-resistant TB strain less deadly than the new one. The outbreak cost $1 billion to contain.

Invest in control

Prevention and containment save money and lives. That's why the United States should help stop the new TB strain from spreading out of control overseas and at home. Public-health advocates are asking Congress to invest $300 million in stanching the worldwide threat, especially in Africa. An additional $250 million would boost U.S. tuberculosis prevention and control programs. Congress should approve the needed funding as an emergency supplemental appropriation. The potential cost of a killer TB outbreak should not be underestimated.

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