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The test of TB

Progress is being made in fighting tuberculosis even as new, harder-to-treat strains arise.

March 24, 2007

IT'S A TRUISM THAT, in movies or novels set in the Victorian era, one shouldn't get too attached to a heroine who coughs. She'll be dead well before the denouement.

Tuberculosis, an airborne bacterium that infects the lungs, isn't the death sentence that it was in the days of the Moulin Rouge. In fact, in the run-up to today's observance of World Tuberculosis Day, which marks the 125th anniversary of the discovery of the microorganism that causes TB, came the release of studies indicating that the disease is on the decline. But the TB bug is wily -- it has a tendency to come roaring back when health officials let down their guards. And new strains are arising that are nearly as resistant to treatment as all forms of the disease were in the 19th century.

The good news is that the focus placed on eradicating TB around the world, which started in the mid-1990s and accelerated at the turn of the century, is paying off. For what may be the first time ever, the percentage of the world population infected with TB held steady or dropped in 2005, according to the World Health Organization. TB is declining close to home as well, with new cases hitting historic lows in California last year and dropping nearly 50% from 1992.

This isn't happening by accident. With the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, combined with a crackdown on the disease in China and Russia, the amount of money spent fighting TB has nearly doubled since 2002 to about $2 billion this year. The latest numbers are strong evidence that eradication programs are working. And with the scary emergence of extensively drug resistant (XDR) TB, they are needed more than ever.

Treating TB requires a strict, long-term regimen of antibiotics; a tendency by patients to fall off this regimen, especially in the developing world, has led to the arrival of XDR-TB, which is extremely hard to treat. Strains of it have been found in 28 countries, and in the first reported outbreak in South Africa, 52 of 53 patients identified with it died. In L.A. County, there have been eight reported cases of XDR-TB since 1993.

There are other serious challenges. Science hasn't advanced much in TB treatment for half a century. Drugs are slow to take effect, and diagnosis techniques aren't very accurate.

Tuberculosis is a disease as old as human civilization. It can't be wiped out overnight or without effort. But this year brings the first significant evidence that the struggle is having an effect, and that's worth celebrating. It also shows that the support of the United States and other wealthy nations remains crucial in this effort.

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