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This is a MAJOR PROBLEM, that needs utmost attention! U.S. Doctors Shouldn’t Have to Beg for TB Drugs



Achievements in Public Health, 1900-1999:

Control of Infectious Diseases

Deaths from infectious diseases have declined markedly in the United States during the 20th century (Figure 1). This decline contributed to a sharp drop in infant and child mortality (1,2) and to the 29.2-year increase in life expectancy (2). In 1900, 30.4% of all deaths occurred among children aged less than 5 years; in 1997, that percentage was only 1.4%. In 1900, the three leading causes of death were pneumonia, tuberculosis (TB), and diarrhea and enteritis, which (together with diphtheria) caused one third of all deaths (Figure 2). Of these deaths, 40% were among children aged less than 5 years (1). In 1997, heart disease and cancers accounted for 54.7% of all deaths, with 4.5% attributable to pneumonia, influenza, and human immunodeficiency virus (HIV) infection (2). Despite this overall progress, one of the most devastating epidemics in human history occurred during the 20th century: the 1918 influenza pandemic that resulted in 20 million deaths, including 500,000 in the United States, in less than 1 year–more than have died in as short a time during any war or famine in the world (3). HIV infection, first recognized in 1981, has caused a pandemic that is still in progress, affecting 33 million people and causing an estimated 13.9 million deaths (4). These episodes illustrate the volatility of infectious disease death rates and the unpredictability of disease emergence.
Public health action to control infectious diseases in the 20th century is based on the 19th century discovery of microorganisms as the cause of many serious diseases (e.g., cholera and TB). Disease control resulted from improvements in sanitation and hygiene, the discovery of antibiotics, and the implementation of universal childhood vaccination programs. Scientific and technologic advances played a major role in each of these areas and are the foundation for today’s disease surveillance and control systems. Scientific findings also have contributed to a new understanding of the evolving relation between humans and microbes (5).
CONTROL OF INFECTIOUS DISEASES
Sanitation and Hygiene
The 19th century shift in population from country to city that accompanied industrialization and immigration led to overcrowding in poor housing served by inadequate or nonexistent public water supplies and waste-disposal systems. These conditions resulted in repeated outbreaks of cholera, dysentery, TB, typhoid fever, influenza, yellow fever, and malaria.



Infectious disease: TB’s revenge

The world is starting to win the war against tuberculosis, but drug-resistant forms pose a new threat.

I am a tuberculosis doctor. My patients and I inhabit a world of TB medications, diagnostic technology and public-health investigations. Together we have celebrated many triumphs over this deadly, but curable, disease.
The problem we are now facing, however, is so threatening that it will take a concerted national effort to prevail. I am talking about the shortage of tuberculosis drugs.
Last December, the Centers for Disease Control and Prevention reported that U.S. supplies of isoniazid, the most important drug in the treatment of TB, were critically low. A national survey of health departments in January reported that 79 percent of responding jurisdictions were having trouble getting the drug.
In California, where tuberculosis cases are the highest in the nation, we have struggled to keep the drug available. Physicians are now being advised by the CDC to ration their isoniazid supplies. As the TB controller for my county’s public-health department, I have to choose which patients get their potentially life-saving medications, and which ones don’t. Alternative regimens without isoniazid exist, but they can be more toxic, longer in duration and more expensive.
Isoniazid is just the latest — albeit the most essential – - drug to be added to the growing list of unavailable or critically low TB medications in the U.S. Many of the other drugs we have relied on — including kanamycin, amikacin and capreomycin — have been difficult to obtain for more than a year.

California First

California is ground zero for TB in the U.S. With 2.3 million Californians infected with M. tuberculosis, we have the most TB disease, the most TB deaths and the greatest number of the most feared form: multidrug-resistant TB. We aren’t exactly chanting “We’re No. 1.” In this emerging era of drug shortages, we are becoming desperate.
How desperate are we?
Desperate enough to turn for help to the Global Drug Facility, a part of the World Health Organization that ensures universal access to TB drugs for even the most impoverished countries. KenyaIndia, the Philippines and Uganda (to name only a few) all rely on the facility for an uninterrupted supply of vital TB medications. The Global Drug Facility is funded partly by the U.S. I sat beside many other TB doctors from around the U.S. when we met with a GDF representative recently, and we all agreed: Asking the GDF for emergency help had to be considered. And last week, in an article about the nationwide isoniazid shortage in the Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention agreed.
How is it that the wealthiest country on Earth could be forced to resort to a Third World solution to treat a disease as dangerous as TB?  >>MORE<<

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