TB Is Now the Top Infectious Killer
npr.org
npr.org
I did a semester-long report on TB in college, and our findings were that multiple drug resistant TB and poly-drug resistant TB would be growing public health problems in poor countries in the coming decades. This was a conservative way of framing that problem. Realistically, TB is wildly infectious, and extremely dangerous to societies that can't afford treatment.
The clinch is that TB is entirely treatable, but it is very money and resource intensive to do so, requiring reliable access to medication and quarantining from healthy people over a long period of time. In poor countries, compliance with single drug regimens isn't great a lot of the time due to nonexistent infrastructure for distribution and treatment monitoring-- requiring a cocktail of drugs to deal with drug resistant TB is no different. Additionally, TB-specific hospitals, where they exist, are largely places that people with TB go to die. Their relatives frequently get infected from visiting a TB-infested hospital den, of course.
The rise of XDR-TB (poly drug resistant) means that a growing number of people get a death sentence from an otherwise treatable disease. The suggestions I made in my college report were to invest in healthcare infrastructure and secured involuntary quarantine facilities; the former to help those with MDR-TB and regular TB, and the latter for the rest, who probably can't be helped rationally under utilitarian economics of a poor country. Best to limit exposure to the healthy.
I highly doubt these measures would be used against TB, though-- it just isn't deadly enough. The countries with high TB infection rates are the ones without a serviceable central government.
One-third of the world's population is thought to have been infected with M. tuberculosis,[3] and new infections occur in about 1% of the population each year. https://en.wikipedia.org/wiki/Tuberculosis
5–10% of the United States population tests positive
I live in LA and a few years back there were several articles written about TB spreading within the homeless population. With all the resources that the US government pays to monitor its population to try to prevent a terrorists from using things like biological weapons, you would think that the US government would be concerned about members of the homeless population that are carrying TB or MDR-TB. The infected homeless are basically untrackable since they most likely don't have bank accounts, home addresses, etc.
If you told the CIA that you knew of an untraceable terrorist sleeper cell in the US spreading a contagious disease, you would likely have their full attention. In some ways this is what's being allowed to happen, even as the US dumps billions into fighting terrorism abroad.
Working to reduce inequality abroad might also help to stop outbreaks like we saw with ebola. I think in the future, people will look back and say "Well of course there was going to be a global pandemic that wiped out X percent of the world population. You can't have a world that is hyper-connected with air travel while simultaneously leaving most of the population in poverty without getting that result."
TB in LA article: http://www.huffingtonpost.com/2013/02/22/tuberculosis-outbre...
http://www.theguardian.com/society/2015/oct/27/tb-rates-in-p...
Some areas (eg Newham) have large minority populations that travel to countries where TB is common, and are often disengaged from the healthcare system. Poor (eg damp) housing sustains it.
That's the vaccine. You can't prevent your way out of an already-blown epidemic, though. I'm also not sure how common that vaccine is, or for how long it's protective, or if it's fully protective.
EDIT: all of the information I am wondering about is in the wikipedia article I linked. Seems like vaccination isn't widespread in a lot of places, including the US.