Princeton not immune to a disease that is making national comeback.
By: Jeff Milgram
It killed King Edward VI of England, Wild West gunslinger Doc Holliday and first lady Eleanor Roosevelt.
It is the leading killer of women and the leading cause of death of people infected with AIDS or HIV.
A third of the world’s population has been infected with latent forms of it, including 15 million in the United States, and a person is exposed to it every second.
It is tuberculosis, an airborne disease so infectious a World Health Organization official called it "Ebola with wings."
And on Monday, the undergraduate-run Princeton Tuberculosis Awareness Group is joining the Princeton Project55 Tuberculosis Initiative and RESULT, a citizens’ advocacy group that fights hunger and poverty, to encourage the federal government to take a global leadership role in TB prevention and control, foster vaccine development and raise public awareness of the disease that kills 2 million people around the globe every year.
Princeton’s observance of Tuberculosis Awareness Day will be held between 11 a.m. and 3 p.m. on Monday on the main level of the Frist Campus Center on Washington Road. Throughout the world, the day will be observed on Sunday, but Princeton students don’t return from spring break until Sunday night.
The students will have an information table and hand out educational and action materials and will be available to answer questions about TB.
The Princeton Tuberculosis Awareness Group was formed by junior Lauren Pellino, who took a course on TB last semester and decided to do something about the global TB crisis.
The group is an undergraduate student organization that is working to promote understanding of the dangers posed by TB, a disease that virtually disappeared in the United States after researchers discovered several drugs to treat it in the 1940s.
But TB has come back. In 1984, the number of TB cases reported in the United States began to increase. More than 26,600 cases were reported in 1992, according to the Centers for Disease Control and Prevention.
Since 1992, the number of reported cases in this country has been on the decline. There were 16,377 cases of active TB in the United States in 2000, a 7-percent decrease from 1999 and a 39-percent decrease from 1992. The CDC believes the nation "is fully recovered from the resurgence of TB that occurred in the late 1980s and is back on track toward TB elimination."
But TB remains a threat for three reasons, the CDC said.
*TB is spreading throughout the world and the percentage of foreign-born residents of the United States who come down with active TB has grown from 22 percent of the national total in 1986 to 44 percent of the national total in 1999.
*The number of multiple-drug resistant cases of TB is on the rise.
*There is a strong interaction between TB and HIV.
The CDC reported that nearly half of the TB cases in the United States in 2000 occurred in foreign-born persons.
Princeton is not immune. Dr. Margaret Lancefield, the medical director of The Princeton Medical Center’s Outpatient Charity Care Clinic, reports that the 4,000 new patients a year served by the clinic are routinely tested for TB and that one or two each year need to be treated for active TB. None has had the multiple-drug resistant strain of TB.
About 70 percent of Dr. Lancefield’s patients are from Central America, India, Pakistan, the former Soviet Union, China and Afghanistan. She estimates that 90 percent of those tested registered positive for exposure to TB. They are given medication to keep their dormant TB from going active later.
"RESULTS volunteers work with our congressional representative/senators and one of our goals is to focus on solutions that have proven to work and then advocate for increased funding for them and other changes in our policies that will help eradicate poverty," said Wilma Solomon, a RESULTS volunteer. "We have the drugs to treat and cure it, if taken properly. Regular drugs are not that expensive."
The connection to AIDS and HIV is easy to find. According to figures from RESULTS, "An HIV-positive person is 30 times more likely to develop active tuberculosis and become infectious to others." And the infection rates for both TB and HIV are expected to rise in Eastern Europe and Asia, RESULTS said.
"We must act to control TB now or pay later," according to Ms. Solomon. "Rising drug resistance is a time bomb that could make TB virtually uncontrollable," she said. "Multi-drug resistant TB is far more dangerous and difficult to treat, can cost up to $1 million per patient to cure and kills half of its victims, even in the U.S."
RESULTS supports the Global Plan to Stop TB, which calls for an additional expenditure of $1 billion a year and an expansion of the use of the directly observed therapy short-course, commonly known as DOTS what RESULTS calls "a proven, a very cost-effective treatment system that uses just $10 worth of drugs to cure a patient in six months."
Federal funding for TB programs increased from "virtually zero in 1997 to $75 million in 2002," Ms. Solomon said. The 2003 federal budget proposes to cut TB funding by 30 percent.
"Just $200 million annually from the U.S. would save tens of thousands of lives around the world and would protect U.S. citizens from TB and from the growing threat of drug-resistant TB," Ms. Solomon said.