Time for White House to step up on TB

The news brought to my mind vivid memories from my work as a physician in southern Africa.

I cannot forget seeing an 8-year-old boy as he crawled outside to play with his friends. Being on all fours was not part of the fun but his only means of mobility. An infection in his knees, caused by multidrug-resistant tuberculosis, left him unable to walk or stand.

While TB usually affects the lungs, in many children it occurs in other parts of the body.

Resilient in the face of his illness, he looked to the sky with a shy grin as the other children shouted "crab, crab, come and get us, crab." But the playful laughter was then replaced by silence: The young boy was killed by MDR-TB, and his sister and mother are also ill with disease.

In my 20 years of experience in treating children with this disease with Partners in Health, the Sentinel Project and others, this case, in the African nation of Lesotho, was one of the most heartbreaking.

Due to a lack of appropriate TB diagnostic tests and medications, this child was sick for months before the cause of his fevers and swollen knees became clear.

Even when the diagnosis was made, he was referred from facility to facility before a provider skilled enough to treat him could be located. The transportation cost for just one visit was more than the family's entire monthly income.

He wept silently when receiving his painful daily injections. Watching his small frame heave and struggle to swallow the multiple, bitter pills was almost too much for his mother to bear, and at times they simply both gave up.

Could this only happen in a place like Lesotho? Actually, there are about 100 cases of MDR-TB diagnosed in the United States each year. These lead to an additional 1,000 exposures and more than 300 infections with MDR-TB over a two- to three-year period, according to the U.S. Centers for Disease Control and Prevention.

In the United States, a case of MDR-TB can cost $400,000 to treat. Patients must take toxic medication daily for two to three years, often causing permanent hearing loss and other side effects.

In 2009, a teacher in a Laguna Beach, Calif., elementary school went to work not knowing she had MDR-TB, inadvertently infecting 31 children. Last year in Florida, 36 TB cases were found to be resistant to at least one TB drug and 10 cases of MDR-TB were confirmed, according to the Florida Department of Health. In Massachusetts, we already have seen six cases of MDR-TB so far this year.

Globally, the number of cases among children is bound to grow. Once on the right treatment, a patient usually becomes noninfectious, but most people with the disease are not receiving treatment, thus making spread to children more likely.

There is some good news. The White House is developing a National Action Plan for Combating Drug Resistant TB, which would put us on course to eliminate the threat of MDR-TB through prevention and treatment with promising new medications now becoming available. Some 560,000 people with drug-resistant TB would receive treatment under the plan over a five-year period. Last summer, 10 U.S. senators wrote to the president commending him for taking this initiative.

Unfortunately, many TB experts worry the president may fail to propose the funding increase required to implement the plan, because in recent years he has proposed not increases but rather substantial cuts to global TB funding. I have signed an appeal to the president, along with 600 other physicians and scientists, including 21 based in Florida, urging him to launch his plan without delay and propose the needed funding.

President Barack Obama has a chance to add to his legacy on global health by confronting the tuberculosis threat. For the sake of the children I am treating for MDR-TB and families affected by this disease, we must not delay. We cannot afford an action plan that just gathers dust on the shelf.

By Dr. Jennifer Furin
Dr. Jennifer Furin is senior lecturer at Harvard Medical School, Department of Global Health and Social Medicine.

Source: Tampa Bay Times