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    Beyond 2000
    Science Races to Stem Tuberculosis Threat

    By Susan Okie
    Washington Post Staff Writer
    Tuesday, August 10, 1999; Page A1

    next century graphic

        TB Bacteria
    Tuberculosis treatment worker Paul Norero watches patient Arnaldo Rolon take his medication. (The Washington Post)
    Arnaldo Rolon fidgets with the pill box lying open on the kitchen table in his apartment in Spanish Harlem. The box has three compartments for each day of the week: two for the drugs that Rolon takes morning and evening to keep the AIDS virus in check, and one for the tuberculosis medicines that he takes at midday under the eye of public health worker Paul Norero.

    “I’m sick and tired of medication,” says Rolon, whose elaborate tattoos don’t hide the scars on his arms left by past drug use. “I don’t be eating. This is my breakfast.”

    Norero smiles and listens. Rolon sips a glass of water and begins to swallow the five pills one by one as he talks about his TB.

    “I was, like, letting it go for a little while when I started coughing blood . . . They found it in my chest. I was in the hospital almost six months. They had me locked up in a special room by myself.”

    Locking someone in a hospital room is sometimes still deemed necessary in 1999 to make sure TB patients take their medicine. Despite all of medical science’s advances, this disease that killed Stone Age hunter-gatherers and Egyptian pharaohs remains one of the world’s two deadliest infections. It kills between 1.5 million and 2 million people per year – almost as many as AIDS. And experts say that toll could increase in the coming years because TB bacteria are evolving new strains that are increasingly resistant to treatment – especially in cases where doctors prescribe ineffective treatments or where patients fail to take all of their pills.

    So public health workers like Norero continue to patrol the ramparts in New York’s – and the world’s – campaign to keep TB in check. If they relax their guard, the continued emergence of drug-resistant strains could, in effect, return the world to the pre-antibiotic era, setting the stage for a global comeback of the disease.

    “If we sit back and allow drug resistance to grow unchecked, we may one day be faced with incurable tuberculosis,” said Kenneth Castro, director of the division of tuberculosis elimination at the federal Centers for Disease Control and Prevention.

    The ongoing war against tuberculosis is emblematic of both the promise and the challenges facing medicine as the world moves into the next millennium. The last century has seen a dramatic increase in human life expectancy, driven in large measure by advances in public health, nutrition and the conquest of infectious diseases. Age-old scourges such as polio, measles and diphtheria are on the wane, and smallpox – a disease that killed an estimated 500 million people during the 20th Century – has been eradicated from the planet except for stocks of the virus that remain in laboratories. Worldwide, more children are surviving the vulnerable early years of life, thanks to improved care during pregnancy and childbirth, immunizations, better diets and cleaner water.

    Yet, despite those milestones and the promise of equally significant advances in the coming decades, the world’s poor continue to die of diseases that are treatable or preventable. Infectious diseases, including TB, still cause one-fifth of all deaths. Drugs for AIDS, cancer and many other disorders that keep many people alive in the United States and Europe are priced too high for most people who live in developing countries. Although smoking continues to decline in Western countries in response to regulation and a barrage of public health messages, it is increasing in developing countries. Globally, by the year 2020, tobacco is expected to cause one in seven adult deaths.

    Even within a wealthy country like our own, there are startling differences in health. An American Indian man from Bennett County, S.D., has a life expectancy of only 56.5 years, compared with 97.7 years for an Asian woma from Bergen County, N.J. That 41-year discrepancy is almost as great as the difference in life expectancies between the country in the world where men die youngest, Sierra Leone, and the one where women live longest, Japan.

    “More than a billion fellow human beings have been left behind in the health revolution,” says Gro H. Brundtland, director-general of the WHO.

    Public health experts say sharing the benefits of medical advances has become more urgent as the world’s population becomes more closely connected. In this era of , people on opposite sides of the planet are no longer isolated from one another, especially when it comes to contagious diseases like tuberculosis and AIDS. A drug-resistant strain of TB that evolved in Russia or Asia can reach New York in less than a day and can spread to anyone who breathes the same air as an infected, coughing person. In one recent incident, a woman with drug-resistant TB coughed into the stuffy air of an airline cabin during a transcontinental flight and infected four of her fellow passengers.

    TB Bacteria
    A bacterium of tuberculosis, also known as Mycobacterium tuberculosis, is pictured through a high-powered microscope. (The Washington Post)
    In the next century, chronic disorders, such as heart disease, stroke, cancer, lung disease and mental illnesses, are expected to cause an increasing share of death and disability throughout the world. Yet, old-fashioned germs like TB remain a potent source of human suffering – and a formidable threat. Recent events have proven that the behavior of disease-causing microbes is hard to predict, especially as we, their hosts, become more numerous, more mobile and more densely packed on the planet.

    During the next quarter century, tuberculosis and AIDS are the only two infections projected to remain among the top 10 leading causes of death. The one that currently takes the greatest toll – AIDS – was first recognized less than two decades ago, demonstrating how rapidly medical forecasts can change.

    Those who predicted the imminent demise of infectious diseases “didn’t account for HIV or for the avian flu,” a deadly new strain of influenza that struck Hong Kong in 1997 and could reappear, said David Heymann, the head of communicable disease programs at the WHO. “Things can happen.”

    Continued on Page Two

    © Copyright 1999 The Washington Post Company

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