San Francisco Chronicle - March 24, 2008

TB, easily spread by a cough or sneeze, is a scourge in poor countries, where months-long drug regimens are beyond the abilities of rudimentary health care systems. Some 9.2 million new cases were reported in 2006, with Asia and Africa especially hard hit.

For more than a decade, the World Health Organization have focused on TB, and initial efforts showed promise as patients were identified and billions were spent on pills and medical care. The goal was to knock TB from its perch as the No. 2 global killer, right after the AIDS virus.

But the U.N.-affiliated agency turned in a disappointing report last week, showing that the steady pace of identifying more TB-infected patients has dropped by half. This means larger numbers are going unspotted and untreated. One TB carrier has the potential to infect 10 to 15 others, the health agency says.

It gets worse. Because so many patients receive only partial treatment or stop taking a daily dose of eight to 10 pills, the TB bug can transform itself into new strains that are tougher to kill. Stronger, more costly drugs are needed for this subgroup. This drug-resistant population, once too small to draw concern, has jumped in size with the potential to spread a more lethal brand of the disease.

The U.N. will need to push harder. It must persuade hard-hit countries to work faster to diagnose and treat the disease. Doing this will take even more money - up to $1 billion more. It's a large bill, but one that will surely grow if nothing is done.

Don't think it's a problem in faraway places. For years, San Francisco has topped the nation's TB charts, due to its role as an immigrant entry point from Asia, dense housing and a large homeless population. The numbers were on the decline until the last two years, when the caseload rose first to 120 and then 143 patients. The rest of the Bay Area likewise has high TB rates that could easily rise save for vigilant, steady care from public health agencies.

Today marks "World TB Day," an opportunity to examine this old and enduring disease, along with strategies to contain it.

Locally, TB experts will gather at San Francisco International Airport, a location that underscores the speed and ease with which the bug can travel around the globe. Along with raising public awareness, these health authorities may bring up another subject closer to home.

Gov. Arnold Schwarzenegger is making it harder to catch and contain TB because of his across-the-board budget cuts that may imperil essential work by a state public health laboratory that performs TB tests. If the cut is made, the time needed to identify the disease from a doctor's office test will increase from 24 hours to six weeks. It's too long a wait for a worried patient and doctor to begin treatment to stop a killer disease.

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