New TB Threat: Global Ties Bring an Ancient Disease to Silicon Valley
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Last year, tuberculosis increased in four of the Bay Area’s five largest counties, and the San Jose area in 2006 had the highest TB rate of any large American metro area, according to data from the U.S. Centers for Disease Control and Prevention and the California Department of Public Health. San Francisco, after an outbreak of TB among Latino day workers in the Mission district, has the highest TB rate of any county in California—quadruple the U.S. rate.
From the bodies of Peruvian mummies to 21st-century tech workers, tuberculosis has been mankind’s dark partner for centuries—a highly infectious disease that never followed the path to eradication of smallpox and polio. One in three people worldwide are infected, and 1.7 million died last year, mostly in poor countries where people lack the access to detection and treatment available in the United States.
No case of TB is easy. The waxy-sheathed, rod-shaped, slow-growing bacteria, if untreated, colonizes the lungs, creating such dense cavities of disease that pieces must sometimes be excised. TB spreads through the air; untreated, one person infects 10 to 15 people a year, according to the World Health Organization.
But among public health officials, nothing is more worrisome than the relative handful of drug-resistant TB cases. WHO and U.S. experts are warily watching the record level of such cases—found from former Soviet prisons to remote provinces in China—as hints of something even scarier on the horizon.
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Treating one drug-resistant case can easily cost several hundred thousand dollars or more—the bill often ends up with the county health department if a patient lacks insurance. And in a growing number of extremely resistant cases—including a few in the Bay Area—there are no drugs that can cure the disease, raising the specter of an infectious, incurable, potentially fatal infection.
With California in a budget crisis—and the state’s total number of TB cases declining—a disaster which hasn’t happened yet is not a high priority for politicians. But that is precisely what worries Bay Area TB officials. They say emerging drug resistance, global travel connections, and Gov. Arnold Schwarzenegger’s plans to cut TB spending will all handicap California’s ability to protect residents from dangerous drug-resistant TB.
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Demographics
Valley’s strong links to other countries If affluent, modern Silicon Valley seems an unlikely hunting ground for a disease often presumed a medieval scourge, nothing could be more wrong. This region has intimate ties to countries with the world’s highest TB burdens, countries where the lack of access to antibiotics and basic health care has allowed the disease to flourish in the 21st century.
Ninety percent of Santa Clara County’s 241 TB cases in 2007 were in students, immigrants, temporary workers, tourists and others born in other countries. At the same time, the number of multi-drug-resistant cases in the county—bacteria resistant to isoniazid and rifampin, the first-line TB antibiotics—jumped from two to seven.
The top five countries of origin for foreign-born people with TB are Mexico, the Philippines, Vietnam, India and China, according to the CDC. Those nationalities are also Santa Clara County’s largest five foreign-born populations. At 430,000 people, they are one-quarter of the county’s total population.
“Our TB reflects the countries of origin that our patients come from, and it’s the Philippines and Vietnam and India where there is a lot of drug resistance,” said Dr. Sundari Mase, Santa Clara County’s former TB control officer, now with the CDC.
Many are not recent immigrants—two-thirds of Santa Clara County’s foreign-born cases have been in the United States for at least five years. In that sense, TB is a public health issue, not an immigration issue, heath officials say.
State health officials estimate there are 2 million foreign-born residents of California infected with latent TB. The great majority will never get sick, but if their immune systems weaken—by way of HIV infection, diabetes, aging or immune-suppressing drugs—their TB could multiply, and they could transmit the disease.
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Loopholes
Screening isn’t always effective The United States screens legal immigrants and refugees for TB before they are allowed to enter the country, by checking medical histories and requiring a chest X-ray for those at risk. But Bay Area health officials say there are loopholes in the nation’s defenses, and that budget cuts will only make the gaps bigger.
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Canada prevents an estimated 600 TB cases a year by screening everyone who plans to stay in the country permanently, for longer than six months if they are coming from a country with a high incidence of TB, or for any length of time if they will be working in health care, education, child care or domestic work, said Dr. Edward Ellis, manager of TB control for the Public Health Agency of Canada.
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The cost of every TB case to local taxpayers is significant.
Santa Clara County spent an average of $18,000 a case in 2007—about $4.3 million total—for drugs, testing and for the labor-intensive contact investigation required for families, co-workers or schoolmates who have contact with an infectious person.
With state and local funding in doubt, Fenstersheib, the county health officer, went to Washington in March to lobby Silicon Valley’s congressional representatives to have Santa Clara County join the dozen U.S. cities and counties that get direct federal TB funding.
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(Posted on April 22, 2008)
Comments
If enough Whites catch the disease and die who will go around telling us that diversity is our greatest strength?
Posted by Howard in Las Vegas at 7:18 PM on April 22
Simple close all the borders and keep them closed. The countries overflowing with people now. The known cases come from those coutries and its not an immigration problem? Plleeaasseeee. Give us a break before these educated idiots kill us all.
Posted by at 8:39 PM on April 22
The good news here is that the execs who are wrecking the American middle class by hiring these H-1bs instead of American high-tech workers will be the ones exposed to their TB at work all day. It couldn’t happen to a nicer group of people.
I’d like to see one of them hacking up pieces of lung tissue into a bloody hankerchief someday, while he tells reporters that working in the microelectronics industry at $80,000 a year is a job “Americans just won’t do anymore.”
Posted by Michael C. Scott at 9:08 PM on April 22
Read Paul Farmer’s book “the pathologies of power” on how TB is spread in prisons and migrant labor camps then spread. Of course, this also happens in the former Soviet Union. Drug resistant TB is a world wide problem because diseases have no respect for national boundaries or walls.
Posted by at 4:39 AM on April 23
Be afraid, be very afraid. One coughing sufferer on an aircraft can infect a lot of passengers. It needs all visitors to a Western country where this especially XDR-TB (resistant to known drugs) is prevalent, to apply at the local consulates in the country of departure to obtain a medical certificate from a specialist doctor there (to avoid fraud). Otherwise the health services of such Western countries are going to experience a plague. it is enough to frighten tourists away from countries where the disease is know to exist such as Africa and South America both where suffers can be working in hotels, etc.
In such countries where HIV/AIDS is a terrible problem. do not expect TB to be tackled competently either.
Posted by Brian Deller at 4:39 AM on April 23
I remember Frosty Wooldridge (FROSTYWOOLDRIDGE.COM) being ridiculed for pointing out how immigrants, particularly from Mexico and Latin America are importing diseases and parasites. Now the truth is emerging in leaps and bounds.
WHY ARE OUR POLITICIANS AND CORPORATE LEADERS SO BENT ON DESTROYING AMERICA FOR THE SAKE OF SHORT-TERM PROFITS? Are these people stone-blind that they can’t see ahead… at the incredible DAMAGE immigration is doing to Americans… to our culture, our heritage, and worst of all, our future generations.
Posted by Fed Up at 7:32 AM on April 23
The Pelosi family is part owner with substancial holdings in an exclusive hotel/resort called Auberdu Soliel & a restaurant chain called Piatti Pelosi which is NON-UNION {Read cheap labor from Mexico, the Philippines, Vietnam, India and China - The top five countries of origin for foreign-born people with TB are. Enjoy your meal!!
Posted by Tim at 10:28 AM on April 23
Imagine when the entire Silicon Valley is offshored to China’s emerging Silicon Valley. Oh we will still have TB, of course, it will just be brought in by our southern neighbors not insourced from another continent.
Posted by Unemployed WASP at 12:59 PM on April 23
Great. Our top five sources of immigrants are also major TB reservoirs.
Better be prepared to have crippled lungs…
Posted by Brendan at 2:03 PM on April 23