5 ms·

TB Is Now the Top Infectious Killer

76 points by cryoshon 11y ago

andyjohnson0 11y ago
Earlier this week the UK media were reporting that some parts of London rates of TB up to 150 cases per 100,000 population - higher than Iraq, Eritrea and Rwanda. http://www.theguardian.com/society/2015/oct/27/tb-rates-in-parts-of-london-worse-than-iraq-eritrea-and-rwanda http://www.theguardian.com/society/2015/oct/27/tb-rates-in-p...
- tomjen3 11y ago
  Any particular reason why? London isn't exactly a third world city and the British have a free healthcare system which should be rich enough to handle the treatment.
  - hugh4 11y ago
    Parts of London are a third-world city, and European governments seem determined to bring ever-increasing amounts of the third world in.
  - andyjohnson0 11y ago
    Poverty and inequality. Some areas (eg Newham) have large minority populations that travel to countries where TB is common, and are often disengaged from the healthcare system. Poor (eg damp) housing sustains it.
cryoshon 11y ago
"There's another TB statistic that's particularly worrisome. The new report estimates that there were roughly half a million cases of multi-drug-resistant TB last year, double the number from the year 2000. Conventional antibiotics can't cure MDR-TB. Treatment can take two years or more with drugs that cause severe side-effects; some patients are left completely deaf." I did a semester-long report on TB in college, and our findings were that multiple drug resistant TB and poly-drug resistant TB would be growing public health problems in poor countries in the coming decades. This was a conservative way of framing that problem. Realistically, TB is wildly infectious, and extremely dangerous to societies that can't afford treatment. The clinch is that TB is entirely treatable, but it is very money and resource intensive to do so, requiring reliable access to medication and quarantining from healthy people over a long period of time. In poor countries, compliance with single drug regimens isn't great a lot of the time due to nonexistent infrastructure for distribution and treatment monitoring-- requiring a cocktail of drugs to deal with drug resistant TB is no different. Additionally, TB-specific hospitals, where they exist, are largely places that people with TB go to die. Their relatives frequently get infected from visiting a TB-infested hospital den, of course. The rise of XDR-TB (poly drug resistant) means that a growing number of people get a death sentence from an otherwise treatable disease. The suggestions I made in my college report were to invest in healthcare infrastructure and secured involuntary quarantine facilities; the former to help those with MDR-TB and regular TB, and the latter for the rest, who probably can't be helped rationally under utilitarian economics of a poor country. Best to limit exposure to the healthy.
- flatline 11y ago
  Very informative, thank you. With regards to the quarantine facilities, ebola showed us that this can be a very touchy subject - the Americans/Europeans swooping in and locking people away. Perhaps the fact that TB is more readily treatable, and that patients will generally recover, will help the situation.
  - cryoshon 11y ago
    Depends, really. During the Ebola scare, the Nigerian government came down extremely hard with military enforced curfews, public water/transit shutdowns, involuntary quarantines, etc. Not only did these "harsh" strategies work, they worked spectacularly at preventing widespread infection. I highly doubt these measures would be used against TB, though-- it just isn't deadly enough. The countries with high TB infection rates are the ones without a serviceable central government.
- Retric 11y ago
  TB is one of those diseases where are best hope seems to be it evolving to be less deadly. One-third of the world's population is thought to have been infected with M. tuberculosis,[3] and new infections occur in about 1% of the population each year. https://en.wikipedia.org/wiki/Tuberculosis https://en.wikipedia.org/wiki/Tuberculosis 5–10% of the United States population tests positive
Dirlewanger 11y ago
More than malaria...? Article mentions nothing about it.
- gsibble 11y ago
  It may be distinguishing between diseases that are transmittable between humans and those that are transmitted by a 3rd party (a mosquito).
- rwallace 11y ago
  It gives the current death rate for TB as 1.5 million per year. That could well now be higher than malaria, yes.
deleted 11y ago
[deleted]
- webkike 11y ago
  The former Soviet Union is not just Russia, much like the former Roman empire is not just Italy.
- jedmeyers 11y ago
  Author did not refer to Russia as the "former Soviet Union". In other countries of the former Soviet Union, such as Ukraine or Belarus, tuberculosis is a huge problem too.
  - deleted 11y ago
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MBCook 11y ago
For anyone interested the PBS Documentary show American Experience had a fantastic episode on TB a month or two ago called "The Forgotten Plague" (although they do talk a bit about how it's coming back thanks to drug resistance at the end). http://www.pbs.org/wgbh/americanexperience/films/plague/ http://www.pbs.org/wgbh/americanexperience/films/plague/
- LandoCalrissian 11y ago
  This was really good, a few things about it really surprised me since my understanding of the history of TB was pretty lacking. Really recommend checking it out.
- deleted 11y ago
  [deleted]
riffraff 11y ago
Am I missing something, or we have had a TB vaccine for almost a century? Wouldn't that be a "trivial" solution to the problem?
- cryoshon 11y ago
  https://en.wikipedia.org/wiki/BCG_vaccine https://en.wikipedia.org/wiki/BCG_vaccine That's the vaccine. You can't prevent your way out of an already-blown epidemic, though. I'm also not sure how common that vaccine is, or for how long it's protective, or if it's fully protective. EDIT: all of the information I am wondering about is in the wikipedia article I linked. Seems like vaccination isn't widespread in a lot of places, including the US.
  - MBCook 11y ago
    Much like Polio, vaccination isn't/wasn't common in the US because it's a preventable disease that was basically eliminated. I think some higher risk people may have gotten it (teachers, medical professionals, etc.) but since the vast majority of people wouldn't ever see TB in person they didn't need the vaccine.
touchofevil 11y ago
I think that the threat of infectious diseases like ebola and TB are among the main reasons for developed nations to get serious about reducing economic inequality both globally and within developed countries. I live in LA and a few years back there were several articles written about TB spreading within the homeless population. With all the resources that the US government pays to monitor its population to try to prevent a terrorists from using things like biological weapons, you would think that the US government would be concerned about members of the homeless population that are carrying TB or MDR-TB. The infected homeless are basically untrackable since they most likely don't have bank accounts, home addresses, etc. If you told the CIA that you knew of an untraceable terrorist sleeper cell in the US spreading a contagious disease, you would likely have their full attention. In some ways this is what's being allowed to happen, even as the US dumps billions into fighting terrorism abroad. Working to reduce inequality abroad might also help to stop outbreaks like we saw with ebola. I think in the future, people will look back and say "Well of course there was going to be a global pandemic that wiped out X percent of the world population. You can't have a world that is hyper-connected with air travel while simultaneously leaving most of the population in poverty without getting that result." TB in LA article: http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbreak-los-angeles_n_2743373.html http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbre...

76 points by cryoshon 11y ago

Earlier this week the UK media were reporting that some parts of London rates of TB up to 150 cases per 100,000 population - higher than Iraq, Eritrea and Rwanda. http://www.theguardian.com/society/2015/oct/27/tb-rates-in-parts-of-london-worse-than-iraq-eritrea-and-rwanda http://www.theguardian.com/society/2015/oct/27/tb-rates-in-p...

tomjen3 11y ago
Any particular reason why? London isn't exactly a third world city and the British have a free healthcare system which should be rich enough to handle the treatment.
- hugh4 11y ago
  Parts of London are a third-world city, and European governments seem determined to bring ever-increasing amounts of the third world in.
- andyjohnson0 11y ago
  Poverty and inequality. Some areas (eg Newham) have large minority populations that travel to countries where TB is common, and are often disengaged from the healthcare system. Poor (eg damp) housing sustains it.

cryoshon 11y ago

"There's another TB statistic that's particularly worrisome. The new report estimates that there were roughly half a million cases of multi-drug-resistant TB last year, double the number from the year 2000. Conventional antibiotics can't cure MDR-TB. Treatment can take two years or more with drugs that cause severe side-effects; some patients are left completely deaf." I did a semester-long report on TB in college, and our findings were that multiple drug resistant TB and poly-drug resistant TB would be growing public health problems in poor countries in the coming decades. This was a conservative way of framing that problem. Realistically, TB is wildly infectious, and extremely dangerous to societies that can't afford treatment. The clinch is that TB is entirely treatable, but it is very money and resource intensive to do so, requiring reliable access to medication and quarantining from healthy people over a long period of time. In poor countries, compliance with single drug regimens isn't great a lot of the time due to nonexistent infrastructure for distribution and treatment monitoring-- requiring a cocktail of drugs to deal with drug resistant TB is no different. Additionally, TB-specific hospitals, where they exist, are largely places that people with TB go to die. Their relatives frequently get infected from visiting a TB-infested hospital den, of course. The rise of XDR-TB (poly drug resistant) means that a growing number of people get a death sentence from an otherwise treatable disease. The suggestions I made in my college report were to invest in healthcare infrastructure and secured involuntary quarantine facilities; the former to help those with MDR-TB and regular TB, and the latter for the rest, who probably can't be helped rationally under utilitarian economics of a poor country. Best to limit exposure to the healthy.

flatline 11y ago
Very informative, thank you. With regards to the quarantine facilities, ebola showed us that this can be a very touchy subject - the Americans/Europeans swooping in and locking people away. Perhaps the fact that TB is more readily treatable, and that patients will generally recover, will help the situation.
- cryoshon 11y ago
  Depends, really. During the Ebola scare, the Nigerian government came down extremely hard with military enforced curfews, public water/transit shutdowns, involuntary quarantines, etc. Not only did these "harsh" strategies work, they worked spectacularly at preventing widespread infection. I highly doubt these measures would be used against TB, though-- it just isn't deadly enough. The countries with high TB infection rates are the ones without a serviceable central government.
Retric 11y ago
TB is one of those diseases where are best hope seems to be it evolving to be less deadly. One-third of the world's population is thought to have been infected with M. tuberculosis,[3] and new infections occur in about 1% of the population each year. https://en.wikipedia.org/wiki/Tuberculosis https://en.wikipedia.org/wiki/Tuberculosis 5–10% of the United States population tests positive

Dirlewanger 11y ago

More than malaria...? Article mentions nothing about it.

gsibble 11y ago
It may be distinguishing between diseases that are transmittable between humans and those that are transmitted by a 3rd party (a mosquito).
rwallace 11y ago
It gives the current death rate for TB as 1.5 million per year. That could well now be higher than malaria, yes.

deleted 11y ago

[deleted]

webkike 11y ago
The former Soviet Union is not just Russia, much like the former Roman empire is not just Italy.
jedmeyers 11y ago
Author did not refer to Russia as the "former Soviet Union". In other countries of the former Soviet Union, such as Ukraine or Belarus, tuberculosis is a huge problem too.
- deleted 11y ago
  [deleted]
  - deleted 11y ago
    [deleted]

MBCook 11y ago

For anyone interested the PBS Documentary show American Experience had a fantastic episode on TB a month or two ago called "The Forgotten Plague" (although they do talk a bit about how it's coming back thanks to drug resistance at the end). http://www.pbs.org/wgbh/americanexperience/films/plague/ http://www.pbs.org/wgbh/americanexperience/films/plague/

LandoCalrissian 11y ago
This was really good, a few things about it really surprised me since my understanding of the history of TB was pretty lacking. Really recommend checking it out.
deleted 11y ago
[deleted]

riffraff 11y ago

Am I missing something, or we have had a TB vaccine for almost a century? Wouldn't that be a "trivial" solution to the problem?

cryoshon 11y ago
https://en.wikipedia.org/wiki/BCG_vaccine https://en.wikipedia.org/wiki/BCG_vaccine That's the vaccine. You can't prevent your way out of an already-blown epidemic, though. I'm also not sure how common that vaccine is, or for how long it's protective, or if it's fully protective. EDIT: all of the information I am wondering about is in the wikipedia article I linked. Seems like vaccination isn't widespread in a lot of places, including the US.
- MBCook 11y ago
  Much like Polio, vaccination isn't/wasn't common in the US because it's a preventable disease that was basically eliminated. I think some higher risk people may have gotten it (teachers, medical professionals, etc.) but since the vast majority of people wouldn't ever see TB in person they didn't need the vaccine.

touchofevil 11y ago

I think that the threat of infectious diseases like ebola and TB are among the main reasons for developed nations to get serious about reducing economic inequality both globally and within developed countries. I live in LA and a few years back there were several articles written about TB spreading within the homeless population. With all the resources that the US government pays to monitor its population to try to prevent a terrorists from using things like biological weapons, you would think that the US government would be concerned about members of the homeless population that are carrying TB or MDR-TB. The infected homeless are basically untrackable since they most likely don't have bank accounts, home addresses, etc. If you told the CIA that you knew of an untraceable terrorist sleeper cell in the US spreading a contagious disease, you would likely have their full attention. In some ways this is what's being allowed to happen, even as the US dumps billions into fighting terrorism abroad. Working to reduce inequality abroad might also help to stop outbreaks like we saw with ebola. I think in the future, people will look back and say "Well of course there was going to be a global pandemic that wiped out X percent of the world population. You can't have a world that is hyper-connected with air travel while simultaneously leaving most of the population in poverty without getting that result." TB in LA article: http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbreak-los-angeles_n_2743373.html http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbre...