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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

World TB Day: Raise the Black Flag

By Gary Evans, Medical Writer

Poet John Keats, gunfighter Doc Holiday, First Lady par excellence Eleanor Roosevelt. All died of an ancient malady once called consumption –because it seemed to "consume" its wan sufferers as it took the life from them breath by bloody breath. Today is World Tuberculosis Day. Raise the black flag.

TB is a treatable disease that still manages to kill millions worldwide, can lie dormant for years until a carrier becomes immune compromised, and has developed strains highly resistant to drug therapy. Impoverished crowded communities in Asia and Africa still suffer the major toll of TB, and U.S. efforts to eliminate the disease seem to have plateaued. Preliminary 2016 TB surveillance data in the United States indicate a drop of 2.7% in reported cases from the prior year, but eradication remains elusive.

“TB cases continue to occur in every state and region in the United States,” the Centers for Disease Control and Prevention reports. “Analysis suggests that eliminating TB will require a dual approach: strengthening existing TB programs/systems to diagnose and treat active TB disease, and intensifying efforts to identify and treat latent TB infection among those who are infected with TB bacteria but are not yet sick.”

The CDC estimates that over the last two decades, TB control efforts have prevented as many as 300,000 people from developing the disease, saving more than $6 billion in costs.

“Unfortunately, these efforts alone will not be sufficient,” the CDC notes. “More than 85% of U.S. TB cases are associated with reactivation of latent TB infection, often acquired years earlier. It’s estimated there are up to 13 million people living in the U.S. with latent TB infection.… While they do not have symptoms and cannot spread the bacteria to others, 5% to 10% of them will eventually develop active TB disease if left untreated.”

TB has plagued humankind for thousands of years because it is both patient and mutable. It is the ultimate opportunistic infection and can demonstrate high levels of resistance if drugs are not administered properly and taken with full compliance.

“Treating a single person for drug-susceptible TB disease costs about $18,000 – some 36 times more than the $500 it costs to proactively treat a person for latent TB infection,” the CDC reports. “The cost for treating drug-resistant TB disease is even higher, ranging from $154,000 to $494,000," up to nearly 1,000 times treatment costs for a latent TB infection.

Gary Evans has written about infectious diseases, occupational health, medical ethics, and a variety of other healthcare issues for more than 25 years. His writing has been honored with five awards for interpretative and analytical reporting by the National Press Club in Washington, DC.