San Francisco Chronicle - Monday, December 20, 1993
Sylvia Rubin, Chronicle Staff Writer

"TB still has a bit of a stigma," concedes Dr. Gisela Schecter, director for the TB control division of the San Francisco Public Health Department. "But with modern drugs and good care and attention, we don't need sanitariums anymore."

During the 19th century, TB -- a chronic bacterial infection spread through the air -- claimed more lives in the United States than any other disease. In time, with gradual improvements in housing, sanitation and medical care, the caseload was dramatically reduced.

But since 1985, in part because of the AIDS epidemic and the increased numbers of immigrants from countries with high TB rates, the disease has re-emerged as a serious public health problem, with the state of New York experiencing the highest rate of infection in 1992. There has been a somewhat erratic but a general increase in TB cases in San Francisco, with the numbers going up slowly in the past three or four years. There have been 332 cases reported in San Francisco so far this year; there were 355 cases reported last year.

The reason for the increase in San Francisco? "The majority of our TB cases are in individuals not born in the United States, and San Francisco is a city of immigrants," says Dr. Frances Taylor, director of the Bureau of Epidemiology and Disease Control at the San Francisco Department of Public Health.

Each year, about 8 million people worldwide develop active TB and 3 million die from the disease, according to the National Institutes of Health. There has been an increase worldwide in recent years of persons with drug-resistant TB, and TB still causes more deaths worldwide than any other infectious disease.

In this country, minorities are affected much more so than Caucasians -- more than 56 percent of active TB cases in the United States were among Hispanics and blacks, according to the National Institutes of Health. In 1992, more than 26,000 active cases of TB were reported in the United States, an increase of 1.5 percent from the previous year.

TB can also pose a greater danger to those infected with HIV. In people with weakened immune systems, TB organisms may overcome the body's defenses and cause the disease to become active, according to the NIH.

But with appropriate antibiotic therapy, TB usually can be cured. "Many people still believe that TB is not treatable; that was true 50 years ago, but that's not true now," Schecter says.

TB usually affects the lungs, although other organs are sometimes involved. On the average, those infected with the TB bacteria have only a 10 percent chance of developing active TB sometime in their lives, according to the NIH. Early symptoms of active TB are weight loss, night sweats and loss of appetite. As the disease progresses, there may be chest pain and coughing.

Prevention is the key: In California, routine periodic screenings are performed at health clinics and homeless shelters, and there are ongoing screenings in jails, where the rate of TB infection tends to be higher, Schecter says. "We also regularly screen immigrants with abnormal X-rays and all new school entrants."

California ranks high nationally in TB case rates, but the numbers are not considered of epidemic proportions. "The only reason we don't have soaring numbers here, like on the East Coast, is because we never dismantled our control programs as they have done in the East," Taylor says. In California, 5,382 cases of TB were reported in 1992, ranking it third nationally, behind New York and Hawaii. San Francisco ranked fourth among U.S. cities in case rates in '92.

"We've been on top of TB all along; we are working hard to maintain control -- it's taking all we've got, but we are taking control. Every county in California does TB control," says Taylor.

You can catch TB only if you spend many, many hours under the same roof with someone who is actively coughing up bacterium. "We say that if someone has spent 100 hours together with a person indoors, say in a vehicle, or living together, and that person was coughing or yelling or even singing aloud, getting those germs out there, there is a higher risk or infection," says Schecter. "As the number of hours together gets lower, the statistical chance of becoming infected becomes less and less," she says.

"We view TB as almost 100 percent curable, if caught practically any time," says Schecter.

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SKIN TEST FOR TB

If you suspect you have been exposed to TB, you will need to take a skin test, a quick and simple procedure involving a pinprick with a needle. If the area around the injection turns red or irritated, you might be infected. Because of a long incubation period, a second skin test is advised six to eight weeks later.

Always watch for outdated information. This article first appeared in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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