Lessons from the TB tourist

TUBERCULOSIS IS an ancient scourge that has proven adept at skirting modern medicine's efforts to treat it. Last month, it made itself an uninvited guest at an American couple's destination wedding on a Greek island. How the groom managed to travel around two continents after warnings that he was carrying an especially dangerous strain is forcing a needed review of US and international procedures for stopping travel by infected persons. Still, the more important issue is the need for a stronger US effort to combat TB, here and abroad, to reduce its incidence worldwide and to limit the spread of the strain that infected Andrew Speaker.

The infection in Speaker's lungs is known as extensively drug resistant TB, or XDR-TB, because its bacteria have developed resistance to several of the antibiotics used to treat TB. In most cases this happens because patients break off antibiotic treatment courses prematurely, giving the most adaptive germs a chance to survive. Patients can also acquire resistant strains from other infectious patients, although scientists believe that resistant strains are no more communicable than regular TB. In parts of South Africa, virtually everyone infected with XDR-TB dies of it.

Tuberculosis of all kinds kills about 1.6 million each year globally. Many victims are AIDS patients whose immune systems have been weakened. Each year, there are an estimated 9 million new TB infections, of which about 2 percent are XDR-TB. In the United States, there were more than 13,000 new cases of TB last year. Forty-nine Americans suffer from XDR-TB.

Congress is considering legislation that would greatly boost TB funding both in the United States and abroad. Senator Edward Kennedy is co sponsor of a bill that would increase from $130 million to $300 million the TB funds available for the Centers for Disease Control and Prevention and state and local health authorities. In addition to supporting treatment, the funds would also finance research into new drugs and vaccines and improved diagnostic tests.

The principal international source of TB funding is the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The United States, the world's biggest donor to the fund, contributed $724 million this year. A bill sponsored by Representative Barbara Lee of California would raise that amount to $1.3 billion. The increase would help developing countries treat TB patients with the full course of first-level medications, which are much less costly than those needed for patients with drug-resistant strains of the disease.

The strange episode of the runaway groom puts a spotlight on the fact that TB must be fought both in the laboratory and in public health clinics. Both approaches require greater support from the United States.