Some incredible photos of a scary disease.

http://www.xdrtb.org/

From their site:

XDR-TB is the abbreviation for extremely drug-resistant tuberculosis, also called extensively drug-resistant tuberculosis. One in three people in the world is infected with dormant TB germs. Only when the bacteria become active do people become ill with TB. Bacteria become active as a result of anything that can reduce the person’s immunity, such as HIV, advancing age or some medical conditions.

See this for the answer. It's politically incorrect to even suggest that inner city blacks and poor immigrants have caused this TB epidemic, but it's hard to spin it any other way.

PC backlash in 5...4...3...2...1

Upswing? Epidemic? What TB epidemic? The overall number of TB cases in the United States has been halved in the past 10 years. Among the fewer cases we're seeing, it's true that drug-resistance is growing, but we're still talking about fewer TB cases overall.

And that scientific article is hardly the Answer. Consider the situation this way--in the past 10 years, TB has been declining rapidly in the United States, however the decline has been mostly among non-Hispanic whites. That leaves behind other groups who haven't seen much improvement, like foreign-born residents or African-Americans. Suddenly, these other groups stick out like sore thumbs when you look at who is getting TB. Are these groups getting more TB than they did before and fueling this "epidemic"? No, they're getting TB at roughly the same rate as 10 years ago, they just make up a bigger proportion of the smaller overall "pie" of TB cases.

This thread should probably be moved to "around the campfire".

Yep, pulmonary TB incidence is in decline, but it's still part of the epidemic that started around 1980. Precipitating factors have been identified as foreign-born immigrants and HIV comorbidity. I don't disagree with what you said, but you're just looking at the last decade, and we have been fighting this epidemic, yes, epidemic, since 1980.

TB *used* to be a disease that was quite uncommon. Not so since 1980. This, like HIV, makes for some interesting theories about why the epidemics occurred, since many of the world's great killers (smallpox, polio, diptheria, etc.) have been either eradicated or pushed into small remnants. There are some that reared their ugly heads again, this time with MDR (multi-drug resistant) factors that make the CDC pull out their hair.

Could you specify what statistics/measures/definitions you're basing this statement on?

If you're referring to the uptick in TB in this country that started in the mid-1980's, that's long over. That peaked in 1992 and we are far below those levels today. In 2007, both the rate and the actual number of cases of TB in the US was the lowest ever recorded (the Federal gov't started keeping track of nationwide TB stats in 1953).

"That peaked in 1992 and we are far below those levels today."

That isn't necessarily true. Those are REPORTED cases. With the serious lack of medical care in this country today, there could be a major problem and the number-counters wouldn't even know.

It's like the unemployment figures. What they're quoting is based on active unemployment claims. They aren't counting the people whose unemployment has run out and are living with relatives, under bridges, or camped out in a hole in the ground under a piece of plywood in the desert.

Always keep in mind that the figures given by any (esp govt) agency are slanted to make them look as good as possible.

Sue

I concede that with any count or survey of a large population, you're never going to count everyone you're after. However, the only logical conclusion is that the undercount is fairly consistent over time, barring any other big changes, which also means that comparing today's TB rate to any earlier year's rate will be comparable in a meaningful way. So today's rate is still lower than 10, 15, 20 years ago.

Otherwise, if you really think that such a large discrepancy is possible last year, then you're left with the alternative conclusion that there could be a hugely variable miscount every year, which makes the numbers completely useless. Is the TB rate now really the lowest since the gov't started keeping count? I don't know, could be a miscount. Was there really an epidemic from 1986-1992? I don't know, could've been a miscount. Is there less TB now than 50 years ago? I think so, but I can't be sure--could've been a miscount.

By the way, the guy hanging out under the plywood in the desert would not be considered "unemployed" if he wasn't actively looking for work. Once you quit looking, you're magically dropped from the ranks of the unemployed. Sounds odd, but it does make perfect sense when you're talking about retirees or people who quit work to take care of their children. And the gov't doesn't rely soley on the unemployment benefit rolls to count the unemployed. They also call tens of thousands of households every single month, so if they call your house and your unemployed friend is crashing on your sofa, that's how the gov't would find out. Then they use that data to estimate what the unemployment rate for the entire country is.

Actually, you are only counted as unemployed if you are looking for work through the unemployment office. The only reason to do that is to collect your unemployment insurance. Once that runs out, even if you're looking, there's no point to go through the government office, so you're not counted.

Sometimes in hard times Congress passes an extension to unemployment benefits- this has the unintended consequence of raising the unemployment numbers, because people who have been out for more than 6 months show up again at the unemployment office.

We're veering way off-topic here, but since unemployment is probably on people's minds lately--

The Bureau of Labor Statistics explains how they estimate the monthly unemployment figures here.

The people out of work, who have run out of unemployment benefits, but are still looking are considered "unemployed" and although not directly tallied like the figures directly from the unemployment benefits rolls, their numbers are estimated monthly through the Current Population Survey (CPS).

Edit: The Labor Department does report just the tally from the unemployment rolls, too. Usually it's called something like "jobless claims". But that number is a subset of the total unemployment figure that the BLS calculates monthly, but the jobless claims number is quicker to tabulate and release to the public so that's usually the number we hear in the news.

Yes, I'm referring to the uptick in TB in this country that started in the mid-1980's. I'm calling that an epidemic. Most epidemiologists would call it the U.S. TB epidemic of 1985 to 1992. I was wrong to cite 1980 as the beginning of the epidemic. It was 1985. You are correct in that the epidemic was aggressively countered in this country.

My point is that since the 1920's to 1985, the incidence of TB in the U.S. was declining steadily. Then it increased sharply until 1992. That would satisfy most definitions of an epidemic.

So, is the epidemic over in the U.S.? The definition of epidemic being an increase in expected infections for a community or region would indicate that it is over. But remember that in 1985 the CDC had a goal of completely eliminating TB by the year 2000. We still have 14k new cases per year. And worldwide the increase of TB and XDR-TB incidence is considered an epidemic. 1.6 million people die worldwide from TB. Not insignificant. Back in 1993 the WHO declared TB a global emergency. To my knowledge they haven't rescinded that clarion call.

I think this issue is a matter of semantics. According to the usually accepted scientific definition of "epidemic" which you stated, the US epidemic was over when TB cases peaked in 1992. There is currently no epidemic of TB in the US.

A casual or lay use of the term "epidemic" might include "a lot of cases of something" which sounds like basically the way you're using it, although I think that's a very confusing way to use it. Yes, there are still a not-insignificant number of Americans developing TB every year, but it's fewer Americans than ever. We still have a long way to go to reach the stated goal of one case per million population. We'd have to get down to three hundred cases a year to realize that dream. However, just because TB exists in the numbers we see today or because there is a campaign to eliminate it does not mean that there is an epidemic of TB in this country.

So I would agree that TB is still a problem in this country, but I would disagree that there is a TB epidemic.

However, you just mentioned "worldwide" in the latest response. The article you linked to and our discussion so far has been about TB in the US. The global situation, in the Third World in particular, is very different from the US situation. If you want to talk about the global TB situation, then I would agree that there is a global epidemic of TB.

Yeah, you are definitely right. I was wrong to refer to it as a current epidemic here in the U.S. I wrongly thought that drug-resistant TB was on the rise in certain communities, but even that is under good control. Oh well, I learn something new every day.

I must admit that my vision was broader than just the U.S. in my general discussion of TB, but yes, strictly speaking of U.S. efforts, we have seen success. I believe I agreed with you on that in the previous post. What I disagreed with you on was that you didn't refer to the epidemic in the 80's and early 90's as an epidemic. But no biggie!

Thanks for correcting me. Always good to learn new stuff.

I just received my Medscape on-line subscription synopsis today and the main article was:

Hot Topic: Epidemiology of Tuberculosis among Foreign-Born Residents of the United States (posted 10/10/08) Tamar F. Barlam, M.D.; Dennis L. Kasper, M.D.

Here is a link to the article, I do not know if it will work if you are not a member (It is my account, so please do not abuse the opportunity, if it works), so here is also the first paragraph:

Link

Although the overall incidence of tuberculosis (TB) is declining in the United States, the number of cases among foreign-born persons has increased. In 2006, foreign-born persons accounted for 57% of all TB cases in this country. TB among foreign-born residents is usually due to reactivation of infection acquired before arrival in the United States. Population-based data are needed to guide strategies for identifying, treating, and preventing TB in foreign-born persons.

Pete

Medscape does require registration, but it's free.

Actually, I read the actual article and I'm surprised that this was published in a prestigious medical journal because this info is nothing new. Everyone uses the same TB registry so to understand the point I made earlier in this thread, just look at these numbers from the CDC here . Scroll down one page to Table 5. This article only covers 2001-2006 but this table I'm referring to goes back to 1993.

Even if you're not really math-savvy, I think the pattern is apparent. Just look at the number of cases among US and foreign-born Americans since 1993. The number of cases among the foreign-born is quite stable over time, but the number of cases among the US-born Americans has fallen significantly since 1993. Then look at what happens to the percentages for the foreign-born--they go up significantly even though the actual number of cases is basically the same because the overall number of cases each year has shrunken.