**[TB Still On Rise In N.]{.underline}[
]{.underline}[Va]{.underline}[.]{.underline}**

**[Drug Resistance, Immigration Cited In Disease\'s
Spread]{.underline}**

[By Leef Smith]{.underline}\
[Washington Post Staff Writer]{.underline}

\
Monday, March 18, 2002; Page A01

Drug resistance, immigration are cited in spread of the contagious
disease.

[Bucking the national trend, tuberculosis continues to rise in Northern
Virginia, where state health officials say immigration is fueling the
spread and new, drug-resistant strains of the contagious disease are
gaining a foothold.]{.underline}

[Figures being released today by the Virginia Department of Health show
that the number of new TB cases increased nearly 5 percent statewide
from 2000 to 2001, with 57 percent of the total \-- 174 of 306 cases \--
occurring in Northern Virginia. ]{.underline}**[\[See end of
article.\]]{.underline}**

[That represents a one-year jump of 17 percent for the region, on top of
a 5 percent rise the year before. The latest tally was boosted by
reports from Prince William County, which recorded an increase of 188
percent with 26 new cases in 2001, and continuing high numbers from
Fairfax. ]{.underline}

[Although state health officials stopped short of declaring the new data
a crisis, they concede that Virginia now stands in contrast to much of
the nation. Officials with the Centers for Disease Control and
Prevention, headquartered in Atlanta, said provisional 2001 reports
indicate that the national TB rate declined slightly last year, for the
ninth year in a row. Actual numbers will not be released until later
this week.]{.underline}

[Consistent with the national trend, Maryland health officials reported
262 cases for 2001, a 7 percent decline from the previous year. The
District\'s numbers, and a more comprehensive breakdown for Maryland,
will be released this week as well.]{.underline}

[Health officials say the rise of TB, a bacterial disease spread through
the air, is largely a consequence of the migration of people from parts
of the world where the disease is common. It is thought that two-thirds
of the cases of TB brought into the United States originated in just
three countries: Mexico, the Philippines and Vietnam. The World Health
Organization declared TB, which kills 2 million people annually, an
international emergency in 1993.]{.underline}

[\"This is a major global health problem and one that is having a direct
impact on Virginia, because it is very much one of the gateway states,\"
said Ram Koppaka, director of the state Department of Health\'s division
of tuberculosis control. \"I would not want people to get the impression
that this is a crisis \[in Virginia. At the same time, it\'s something
people need to be aware of. TB is not gone.\"]{.underline}

[Although U.S. doctors have the drugs and knowledge to treat TB, health
experts say it could spread in this country if it is not brought under
control in the rest of the world.]{.underline}

[The problem is exacerbated in the United States because underinsured
patients often balk at the cost of treatment \-- prescription
co-payments can run as high as \$100 a month for the six to nine
months\' duration \-- and take themselves off the drugs prematurely,
increasing their susceptibility to multi-drug-resistant strains of TB.
As a result, the more dangerous permutations also are on the rise,
according to health statisticians. ]{.underline}

[\"From a public health perspective, poorly supervised or incomplete
treatment of TB is worse than no treatment,\" because patients can pass
on a drug-resistant strain to others and will require years of treatment
at 100 times the original cost, WHO said.]{.underline}

[Virginia is one of two states (Washington is the other) that does not
automatically provide free medication to anyone with TB, though
officials in Richmond say that, in practice, no one is denied treatment.
Drug costs are fully covered for the indigent, they say, and in cases
where private insurance doesn\'t cover the tab, the state uses a sliding
scale based on income to determine how much of a drug bill a patient
must pay.]{.underline}

[In 2001, there were 10 new reports of multi-drug-resistant TB in
Virginia, up from seven cases in 2000 and four in 1999. Six of 10 new
cases were in Fairfax County.]{.underline}

[Multi-drug-resistant strains are particularly alarming to health
officials because treatment can stretch over several years and cost tens
of thousands of dollars for hospital stays, intravenous drugs,
chemotherapy and sometimes even surgery to repair damaged
lungs.]{.underline}

[Lee Reichman is executive director of the New Jersey Medical School
National Tuberculosis Center and the author of the 2002book \"Time bomb:
The Global Epidemic of Multi-Drug Resistant Tuberculosis.\"]{.underline}

[Virginia, he noted, pays the full cost of treating sexually transmitted
diseases and recently footed the bill for anthrax medication. Not doing
the same for TB is not only shortsighted but \"disgraceful and
appalling,\" he said.]{.underline}

[\"The first, second, third, four and fifth rules of public health say
if you have a condition that affects the greater society more than the
individual person and you don\'t make it worth his while to take his
medicine, then what\'s he going to do?\" Reichman said. \"He\'s going to
stop taking the medicine, which is against society\'s
interest.\"]{.underline}

[In a statement last week, Virginia\'s acting health commissioner,
Robert Stroube, defended the state\'s policy as a way to \"prioritize
limited resources so that the neediest Virginians can be served at no
cost to them\" while taxpayers are spared funding full treatment for
everyone.]{.underline}

[James Lamberti, a Northern Virginia pulmonologist who heads the TB
advisory committee of the Virginia chapter of the American Lung
Association, said the state needs to do more to make sure that people
with tuberculosis obtain, and complete, their drug regimen.
]{.underline}

[\"The Department of Health tells you no one goes without medication,
but the truth is, it\'s a lot of paperwork and sometimes patients slip
through the cracks,\" Lamberti said. \"We need to be doing everything we
can.\"]{.underline}

[The cost to the state of providing drugs for everyone would be
negligible compared with paying to combat drug-resistant strains, he
said.]{.underline}

[Testing for TB among people entering the country is currently limited
to those who apply for immigrant or refugee visas. If active TB is
found, the patient must undergo drug treatment.]{.underline}

[With the amount of traveling people do nowadays, health experts agree
with Reichman when he says, \"To control TB anywhere, you have to
control it everywhere.\"]{.underline}

[Ken Castro, director of TB elimination at the CDC, said health
officials are working on new strategies for combating the spread of TB,
which strikes somewhere in the world every second \-- about 31 million
people are exposed each year, and about 8 million become sick, according
to WHO figures.]{.underline}

[Testing everyone before any travel is not the answer, Castro said.
\"Imagine if you needed a chest X-ray to go to London or France\" on
vacation, he said. \"The more important way to solve the problem is to
reduce the rate in countries that are highly impacted,\" he
said.]{.underline}

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