TB cases in the state on the rise

The Virginia Department of Health reported a slight increase in the number of tuberculosis cases in 2002, despite a steady decline over the last two decades, said Wendy A. Heirendt.

Heirendt and Margaret A. Tipple, M.D., of the Division of Tuberculosis Control spoke about the disease Friday to a group of regional doctors and nurses at the McCoart Administration Center.

“Last year in Virginia we had 315,” Heirendt said of the number of cases reported in 2002.

More than half of the cases were reported in Northern Virginia.

In 2002, Heirendt said, Arlington County reported 39 cases of tuberculosis, Fairfax County had 98 cases. Prince William County had 20 cases. Loudoun County and Alexandria each reported 10 cases of tuberculosis.

In 2001, officials reported 306 cases of tuberculosis.

The tuberculosis division, Tipple said, meets annually with health care workers to give updates on tuberculosis treatments and strategies, and to find those with the disease and get them treatment.

“Our day-to-day activities are a number of things, but we’re the designated place where all of the cases are reported. All of these people report their cases to us,” said Tipple, the division director. “This particular conference is for health care workers in Northern Virginia or anyone else for whom TB is an interest.

“Most of the people here today are health care workers who are doing TB care everyday as a major part of their duties. This is a once-a-year, formal occasion where we honor their hard work. Usually we use it as a way to bring across new information on TB.”

As the regions report to the division, the division reports to the Centers for Disease Control, Tipple said. “We forward our surveillance data to the CDC, where it becomes part of the national surveillance,” she said

Heirendt, the division’s surveillance and epidemiology coordinator, said the increase in tuberculosis cases may be attributable to an increase in immigration from countries where the disease goes untreated.

Immigrants from Vietnam, the Philippines, Bolivia, China, Honduras, Peru, Mexico and India comprise 68 percent of tuberculosis cases in the United States.

The disease can take up to five years to manifest itself, Heirendt said. She said that’s why the division’s impetus is directed at finding and treating those with the disease.

Heirendt said the division’s task is to find the disease, treat the disease and kill the disease.

One impediment to eradicating the disease is patients’ reluctance to complete treatment, Heirendt said.

“We’re looking at six to nine months, and after the first month or two you start feeling better,” Heirendt said.

When people start feeling better, they begin to relax in their regimen, she said. Additionally, the amount of medication people must take is daunting, Heirendt said.

“You’re taking multiple medications. Not just one or two, you’re taking a handful. You’re looking a 10 to 15 pills and you’re taking them everyday and it’s a bother,” Heirendt said.

Problems arise when patients lapse in their treatment. The disease becomes harder to treat.

“We do have drug resistance out there, but we just have to change medicines and be very careful about which ones we use,” Heirendt said.

Dr. Alisan Ansher of the Prince William County Health Department attended the meeting Friday and said it’s important for health care workers to meet with each other occasionally for updates on strategy and methods.

“If we’re up to date on treatment changes, we can educate the physicians in our community. Unfortunately, in the not too distant past, people weren’t used to treating TB,” Ansher said.

Tipple said people could have tuberculosis and not know, and those around them might not notice the disease either.

“The unfortunate thing is that almost every illness starts with flu-like symptoms and anything that you can name starts that way,” Tipple said.

A persistent cough might indicate tuberculosis, Tipple said.

“A cough that doesn’t go away after two or three weeks … fever. Night sweats are fairly common, weight loss, feeling crummy, but the productive cough is the thing we worry about, because that’s how you get those TB bacteria from your lungs when you’re coughing it out into the air where the next person can get it,” Tipple said.

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