A sudden spread of tuberculosis among Americans who cannot or will not seek treatment has U.S. public health officials scrambling for more creative ways to reach the infected.
Modern medicine held TB in check for nearly 30 years. Because it was believed no longer to be a threat, sanitariums were closed, some key antibiotics specific for the disease were retired and routine TB tests stopped.Now a 10 percent rise in the incidence of the disease each year in the United States since 1985, coupled with the development of new deadly drug-resistant strains, has exposed flaws in the health system.
Tuberculosis bacteria are spread through the cough or sneeze of an infected person. Many people become carriers without developing active infection. Symptoms of active infection are frequent coughing, night-time sweats, chest pain, fever and shortness of breath.
The Atlanta-based Centers for Disease Control reported 26,283 new active U.S. cases of TB in 1991, a 2.3 percent increase over 1990 and an 11.9 percent rise from 1989.
And the American Lung Association, formed in the early 1900s to combat TB, issued alarming statistics this week saying there are 20 million people worldwide with active TB.
In the first half of the century TB was virtually a death sentence, but now the disease can be reversed. The key is patients co-operating by taking antibiotics for many months.
The resurgent disease has taken root in society's most vulnerable group - the inner-city poor and homeless - who often lack transportation to reach treatment centers and are far more worried about daily food and shelter than TB.
They tend to stop visiting health clinics when they start feeling better, giving the strongest strains of the TB bacteria a chance to grow. A few months later they are back with a more potent, drug-resistant strain.
Researchers have found direct observation of people taking their medicine is the only sure cure. So one idea is to give the infected a hot lunch, vouchers for food or clothing or cash incentives to take regular medication.
Jailing of patients who refuse treatment is also being discussed. New York City and the New York Civil Liberties Union are working jointly on detention rules to be used as a last resort.