In the past, the groups at greatest risk of developing multi-drug resistant tuberculosis (TB) included HIV patients, prisoners, and the homeless. Today, however, it is more likely that new cases of the resistant form of the potentially deadly disease will be brought into the country by immigrants who have traveled from areas where there is a "raging pandemic" of TB.
Drug-resistant TB arises when ineffective drugs are prescribed or infected patients stop taking their medication too soon thereby allowing mutant strains of the TB bacteria to multiply. Once this type of mutant strain arises it is capable of person-to-person transmission. Whereas multidrug-resistant TB had been resistant to 2 or 3 drugs in the past, todayÃs strains are resistant to 6 to 11 drugs.
A report in todayÃs Journal of the American Medical Association (JAMA) also reveals that California has the largest concentration of drug-resistant TB cases in the U.S. with 37 in 2004. California has gone from about 20% of the nations total cases in 2001 to an estimated 33% at present. According to the JAMA report by Dr. Reuben Granich of the Centers for Disease Control and Prevention (CDC), most of CaliforniaÃs multidrug-resistant cases of TB involve people born outside of the United States. Dr. Granich believes that the key to controlling the problem lies in caring for immigrants and enhancing TB care overseas and not in closing the borders.
Although the overall number of cases of multidrug-resistant cases of TB has declined by 76% since outbreaks in 1993, CaliforniaÃs total number of cases has "stagnated." The California Department of Health is concerned with the problem of imported multidrug-resistant TB since immigrants are often poor, frightened, and prone to move frequently. The 37 California cases in 2004 cost $8.72 million in direct medical costs and contact tracing when you include the 120 people who developed latent infections from them. Normal TB cases can usually be treated in 6 months with about $2,000 of standard antibiotics. Cases of multidrug-resistant TB can take anywhere from 18 to 36 months to treat. The cost of the often toxic, second-line drugs required can be between $28,000 and $1.2 million per patient.