AN OLD FOE RETURNS 


;It isn't the kind of conversation most would choose to have over lunch, but on March 23, in honor of World TB Day the following day, officials at the Orange County Health Department brought in food to their fourth-floor conference room for an educational session on what was once termed "the people's disease": tuberculosis.

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;Judging by the attendance — about 20 staffers (one even uttering that she was "just here for the food") and one reporter — it doesn't look like TB is much of a concern in Orange County.

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;"We'd like to thank the one reporter, from Orlando Weekly, for showing up," says Rick Stevens, tuberculosis program/surveillance coordinator for the Florida Department of Health. Behind him some rewinding, black-and-white images of rows of sanitarium sickbeds flash from a PBS documentary titled The People's Plague.

;;Lack of interest notwithstanding, TB is a problem. Florida ranked fourth in the nation in tuberculosis cases last year, with 1,037. Orange County ranked second only to Dade County in the state with 103 cases, or 10 percent of the statewide total. And while Stevens suggests that these numbers represent a steady pattern of infection — one comprising largely foreign-born service workers, HIV sufferers and the homeless — the news from beyond Orange County and Florida is considerably more dire. The development of Extensively Drug-Resistant tuberculosis (XDR-TB) is causing a new global crisis, one that threatens a new pandemic of the disease that most Americans think is a thing of the past.

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; "It wasn't eradicated," says Stevens. "What they were doing was they were projecting its eradication. Therefore, they started taking funding away, and even some of the drug companies stopped making some of the drugs. They said, ‘Hey, this is a dead issue.' Well, it wasn't."

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;Tuberculosis dates back to antiquity; it's referred to in the Bible as "consumption." In the United States, TB blossomed as a health threat in the 1800s. Some 600 sanitariums were built across the country to treat patients prior to the advent of antibiotics. When an effective treatment finally became available in 1946, most sanitariums closed. Only A.G. Holley State Hospital, in Lantana, remains in operation.

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;By the 1970s, the pandemic seemed to be under control. But after the Vietnam War, which brought many immigrants to the United States, and with the introduction of HIV and AIDS in the early '80s, tuberculosis was back on the rise. Since then the disease has been treated with a series of front-line and secondary medications, typically taken for up to six months.

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;Stevens says that tuberculosis isn't as contagious as most think. The bacteria are airborne and can stay airborne for a few hours, but in order for them to reach the far regions of the lungs and infect someone, direct exposure of at least eight hours is required. Those in correctional facilities are especially at risk, as are those in high-risk lifestyles.

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;"Let's put it this way: When a person is drug-dependent and they live day-to-day to get that high, all other health issues take a back seat, including good nutrition and exercise," he says. "Anything that will weaken the immune system, if TB comes along and you're exposed to it, then you're going to have a higher chance of breaking down to the active state."

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;Lori Theisen works as a case manager for tuberculosis patients at the Orange County Health Department; she oversees their care, gets them treatment, makes certain they complete it and follows up with them.

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;"We do counseling on how TB is different," she says. "You can have cancer or you can have other illnesses and decide not to get treated for those. TB is a different story. You have to get treated. There are laws in Florida that say that people must comply with treatment, or else we can get what they call an emergency hold order."

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;It's a tough job. Asked about the general initial reaction of patients to the news of their affliction, she pauses uncomfortably.

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;"It really varies. A lot depends on how much they already know about TB. Some people are embarrassed by it, some people think of it as any other illness. But knowing, too, if they're in a contagious state, that they have to be isolated, so to speak, for a while, that can be hard on the person."

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;Most of her patients have no idea about the newer XDR-TB, she says, and as of yet there have been very few cases in Florida; just two last year.

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;But that's no reason to ignore the threat, says Pam Myers of Mount Dora. Myers is a member of RESULTS, a citizens advocacy group that aims to influence congress on issues of poverty and hunger. She has a personal stake in the tuberculosis issue: Her grandfather, Dr. J. Arthur Myers, dedicated his life to eradicating the disease after surviving it himself (his mother had succumbed to it) in the 1920s. He died in 1978 at the age of 89.

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;"I just remember him saying one of these years that it's going to come back real strong, and now it's really happening," she says.

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;One of the main reasons for the recent proliferation of XDR-TB, predominantly in Africa and Eastern Europe, is that many tuberculosis patients, feeling that they have been cured prior to completing their medication, sell the remainder of their drugs on the black market, thus allowing the disease to mutate within them.

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;In an article for the nonprofit media newsletter Florida Forum, Myers writes, "The president has sent his Emergency Defense Supplemental request to congress and it contains monies for Avian Flu, which is a theoretical emergency. XDR-TB is a REAL emergency. Ideally, we need an emergency allocation of $300 million to fight XDR-TB worldwide, and $252 million for the fight in the U.S. before it's too late."

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;So far, the response from the government has been less than favorable.

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;"We're kind of disappointed in [U.S. Rep.] Ric Keller," she says. "He just won't listen, but we'll keep trying. You know, one of these days he's going to realize that this is an important issue of our time."

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;She points out that 1.6 million people die annually worldwide from TB. And, she notes, due to international travel, it's only a matter of time before TB is more common here.

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;"We need to start the dialogue, to get people talking about it," she says. "The fact that it's not right in their lap right now ;doesn't mean that it might not be. We might really see something progressing here if we don't get working on it."

; bmanes@orlandoweekly.com

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