TB or not To Be
A play on Shakespeare’s words does little to detract from the seriousness of tuberculosis (TB). In recent years, in fact, there has been a resurgence of this age-old malady in the United States and here on the border. Although the epicenter of TB in the U.S. continues to be New York, it must be acknowledged, realistically, that TB is reentering the mainstream of medicine and the delivery of health care everywhere. Alarmists, vested interests, and others have decried the decline in still-needed programs and warn that case rates will rise.
As you know, tuberculosis is a disease that, because of its airborne transmission, has great public health significance, sometimes pitting the concerns and desires of the diseased individual against the public good. The goals of public health are threefold and include prompt diagnosis and treatment, prevention of transmission to others in the community, and identification of those infected with Mycobacterium tuberculosis who are at high risk for developing disease, and therefore candidates for preventive treatment.
Disease surveillance is of paramount importance. Suspected and confirmed cases of TB must be reported to public health authorities. Following closely on its heels is case containment. By assuring appropriate and complete treatment of cases, the chain of transmission is cut.
There is a saying that “treatment is prevention,” and this should remain the cornerstone of tuberculosis control efforts. The next important task is to target tuberculosis-infected individuals at high risk of developing active tuberculosis, and provide them with preventive treatment. Preventive activities, as you can well imagine, can be quite difficult since the “patient” is not sick. Issues such as adherence to treatment become magnified, and there is absolutely no mandate (and perhaps there should not be one) to require treatment.
Clear national guidelines describing the goals and objectives of tuberculosis control have been published by the Centers for Disease Control and Prevention. It is the responsibility of El Paso’s tuberculosis control programs to implement them.
Tuberculosis has retreated into selected and epidemiologically defined high risk groups, and this has made it harder to attend to public health concerns. Advocacy for tuberculosis control efforts is difficult because those with the disease are seen as “others” who have no relationship or relevance to the public at large, except as threats (for example, foreign born, injection drug users, homosexuals, alcoholics, prisoners, etc.).
The public health sector indeed has some unique responsibilities in terms of tuberculosis control in the El Paso Community. It should provide coordination, management, and oversight of all aspects of tuberculosis control. This sine qua non of public health will ensure that “TB is not To Be.”
As you know, tuberculosis is a disease that, because of its airborne transmission, has great public health significance, sometimes pitting the concerns and desires of the diseased individual against the public good. The goals of public health are threefold and include prompt diagnosis and treatment, prevention of transmission to others in the community, and identification of those infected with Mycobacterium tuberculosis who are at high risk for developing disease, and therefore candidates for preventive treatment.
Disease surveillance is of paramount importance. Suspected and confirmed cases of TB must be reported to public health authorities. Following closely on its heels is case containment. By assuring appropriate and complete treatment of cases, the chain of transmission is cut.
There is a saying that “treatment is prevention,” and this should remain the cornerstone of tuberculosis control efforts. The next important task is to target tuberculosis-infected individuals at high risk of developing active tuberculosis, and provide them with preventive treatment. Preventive activities, as you can well imagine, can be quite difficult since the “patient” is not sick. Issues such as adherence to treatment become magnified, and there is absolutely no mandate (and perhaps there should not be one) to require treatment.
Clear national guidelines describing the goals and objectives of tuberculosis control have been published by the Centers for Disease Control and Prevention. It is the responsibility of El Paso’s tuberculosis control programs to implement them.
Tuberculosis has retreated into selected and epidemiologically defined high risk groups, and this has made it harder to attend to public health concerns. Advocacy for tuberculosis control efforts is difficult because those with the disease are seen as “others” who have no relationship or relevance to the public at large, except as threats (for example, foreign born, injection drug users, homosexuals, alcoholics, prisoners, etc.).
The public health sector indeed has some unique responsibilities in terms of tuberculosis control in the El Paso Community. It should provide coordination, management, and oversight of all aspects of tuberculosis control. This sine qua non of public health will ensure that “TB is not To Be.”
Copyright 2004, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/10/2006 12:53:00 PM
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