Published: 10.02.2006

TB rare in Arizona, but virulent strain 'airplane ride away'


The Arizona Republic


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Arizona health officials say tuberculosis is under control in the state despite growing national concern over imported drug-resistant strains of a disease that hasn't flourished in the United States since the mid-1900s.
Authorities are still on the lookout for especially virulent strains that could come from Mexico or other countries.
"It's just an airplane ride away," said Dr. Karen Lewis, tuberculosis-control officer for the Arizona Department of Health Services.
The majority of drug-resistant infections are brought to the U.S. by legal visitors, many of them unaware that they carry the deadliest strains.
Lewis said those strains develop when patients interrupt their monthslong treatments, giving the still lurking infection a chance to mutate.
In 2005, the most important risk factor associated with tuberculosis in Arizona and nationwide was birth outside the U.S., according to the state's Tuberculosis Surveillance Report, released last week.
Local and national health experts say a recent tuberculosis outbreak in other countries, such as South Africa, where 50 people recently died of an "extensively drug-resistant" strain, underscores the need for testing.
The "extensively drug-resistant" tuberculosis has been found in limited numbers in the U.S, with 74 reported cases since 1993, officials said.
The strain is nearly impossible to cure because it is immune to the best first- and second-line tuberculosis drugs.
It's as easily transmitted as the simple strain.
Nationwide, there has been a spike in milder but lethal "multidrug-resistant" tuberculosis, which responds to more treatments but can cost up to $250,000 and take several years to cure.
About 130 people in the U.S. were diagnosed with multidrug-resistant tuberculosis in 2004, up 13 percent from 2003.
More than 40 cases in Arizona were found to be resistant to one or more forms of anti-tuberculosis medication, according to the 2005 report.
That year, Arizona reported 281 active tuberculosis infections.
A total of 172 infected people were foreign-born, 68 percent from Mexico, where the tuberculosis incidence rate is 10 times higher than in Arizona.
The report documented a 3 percent increase in tuberculosis in Arizona over the previous year.
Still, officials say there is no cause for alarm.
The state has seen a stable number of infections, ranging from 254 to 296 cases, in the past 10 years.
Also in that time, a population surge has decreased tuberculosis rates in Arizona from 6.1 cases per 100,000 people in 1996 to 4.6 in 2005.
Lewis said it's not that easy to catch the disease.
Just 10 percent to 30 percent of those living with an infected person are likely to become ill.
Yet the risk of being infected with the disease is real for first responders.
Firefighters and paramedics wear gloves, eye protection and masks when dealing with all patients.
They are regularly tested for tuberculosis and other infectious diseases.
Similarly, the Arizona Department of Health Services' strategy for controlling the incidence rate is to test people who are highly susceptible, including non-natives
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