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A New War on TB : Myths and Poor Medical Care Have Allowed Tuberculosis to Make a Comeback, but O.C. Health Officials Are Ready to Get Tougher in Their Battle Against This Potential Killer

January 09, 1994|STEVE EMMONS | TIMES STAFF WRITER

Arrested by police and brought to UCI Medical Center last month, the man was confined to a hospital bed and closely watched. Yet one night the hospital staff found the bed empty.

Police, quickly alerted by health workers, began a search, for there was no telling how many people the man could harm if allowed on the outside.

This was no Hannibal Lecter. This was a man in his 20s with no record of violence but who nonetheless was carrying something deadly: tuberculosis.

It's the disease that's so hard to catch and so easy to cure, the disease we thought was wiped out. Yet tuberculosis still kills more people in the world than any other infectious disease.

It's on the rise even in suburbanized Orange County. Never really absent, TB has been on a five-year increase here, and now local health officials are stepping up their attack. For not only are there more cases, there are more people unconcerned with saving themselves and others.

"I think you just have to look at some of the changes in society," says Rick Greenwood, deputy director of public health for Orange County. "There's more homelessness, more drug use, and that gets mixed into the tuberculosis problem. You have to take your medication for a long time--it requires a routine--and these people have other problems. They are irresponsible, and we are asking them to act responsibly."

These people wind up in jails and other institutions, where they can infect others, Greenwood says. Five cases turned up in Orange County Jail last year, prompting tests of other inmates but uncovering no unusual outbreak.

But the disease is found in more respectable settings as well. Discovering TB cases among students at La Quinta High School in Westminster last spring prompted testing both there and at Golden West College in Huntington Beach, where one of the students attended a class. Again, no unusual outbreak was detected.

County health officials say they will be more aggressive in 1994, demanding quicker notification from health-care providers and institutions so they can act fast. They will order tests of students entering school for the first time, which has been optional in recent years. And they will be quicker to force compliance when cooperation is not forthcoming.

A new state law proposed by state and county health officers took effect Jan. 1, clarifying how health officers may enforce TB quarantine and treatment. In Orange County, health officials have conferred with the district attorney, preparing for what they fear may be more cases of uncooperative people.

"It's rare," Greenwood says. "Almost always when you get a chance to explain things, people cooperate. And it usually only takes three or four weeks of treatment until a person is no longer contagious.

"But we had two people in the last six weeks" who refused to follow treatment programs and for whom arrest warrants were issued, Greenwood says. One was arrested and sent to a hospital ward; the other has moved away from the county, officers believe.

Greenwood, who has a budget of $4.5 million and 70 health workers to fight TB in the county, says he thinks the increase in cases has reached a plateau. The struggle now may be to resume the steady decline that had continued through most of the '80s.

The irony of TB is that while it is the oldest scourge of human beings that we know of--the World Health Organization calls it "humanity's greatest killer" even today--it is usually difficult to contract and easy to cure.

The bacteria is transmitted in tiny droplets exhaled in the breath. A person must be in close, prolonged contact with a contagious person--perhaps six to eight hours a day for six months--before the TB bacteria settles in the lungs. Even then, a healthy person's immune system can suppress the infection.

But often some bacteria survive and wait for the immune system to lose its punch through age or illness. (AIDS victims are particularly vulnerable.) Then bacteria contracted perhaps 50 years earlier can revive and spread, eating away at the lungs and other organs.

Plentiful and cheap antibiotics taken regularly for six to 12 months purge the body of lingering TB bacteria.

But for active cases, four antibiotics are taken simultaneously for nine months to a year. The reason is that the first attack on the bacteria must succeed. Each failure, usually in patients who stop taking their medication too soon, makes the bacteria more difficult to cure.

About one in 10 billion TB bacteria will change its characteristics when it reproduces, and these new, mutated bacteria often are resistant to one or another type of antibiotics. If all the bacteria are not killed in the first attack, they have time to develop super-resistant strains.

"That's what they have back East," Greenwood says. "They have bacteria that are resistant to three or four different kinds of antibiotics." Health officials have called for increased drug research because they are running out of alternative antibiotics, Greenwood says.

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