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Global epidemic, local threat Tuberculosis: Too few cities follow Baltimore's example of effective treatment.


WASHINGTON, D.C., just down the interstate, has discovered an alarming rise in the number of tuberculosis cases among its residents -- with reported cases increasing by more than 50 percent in the past year.

Worse, the city's ability to deal with the crisis has "shocking deficiencies," according to a recent report by the D.C. Medical Society and the American Lung Association. Those deficiencies include shortages of TB medicine, inadequate laboratory tests and too few cars -- only one of the five cars allotted to the city's TB bureau is available and reliable.

That's scary news -- and given the proximity of the two cities, it could threaten Baltimore's TB success story. Unlike AIDS, TB is highly contagious -- easily transmitted through a cough or sneeze. Unless the District gets a handle on this problem soon, it puts thousands of people at risk.

Getting a handle on TB is not complicated, but it demands perseverance. Baltimore's story is instructive. Beginning in 1965, Baltimore consistently ranked in the top three major U.S. cities in the incidence of TB. But in 1978, the city health department initiated a program of "directly observed therapy," in which public health nurses saw TB patients every day for several months to make sure they took the doses of medicine required to cure the disease.

After three years, Baltimore's incidence of TB had dropped from 48 per 100,000 to fewer than 36. That same year, 1981, the city intensified its efforts, expanding the program beyond clinics by sending dedicated young nurses to track down recalcitrant patients. Within a decade, the 1981 rate had been halved. In 1993, when New York City reported some 800 cases of a troubling new drug-resistant strain of TB, Baltimore had one -- a New Yorker whose disease was diagnosed here.

The District's health crisis mirrors an alarming rise in TB cases around the world. According to the World Health Organization, nearly 3 million people died from tuberculosis in 1995, more than at the height of the TB epidemic around the turn of the century, when the disease caused some 2.1 million deaths each year.

Crowded prisons and homeless shelters are said to be a major contributor to Washington's TB rate. But this problem cannot be confined to the poor and outcast. The return of TB is a public health emergency in the widest sense.

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