New York Times article on

RESISTING DRUGS, TB SPREADS FAST IN THE WEALTHY WESTERN NATIONS|
(bl)|
By DONALD G. McNEIL Jr.|

 AMSTERDAM, Netherlands — Deadly strains of drug-resistant tuberculosis are increasing not just in poor countries but in wealthy Western ones, according to a new report from the World Health Organization and other groups.  The report, to be released Friday at a tuberculosis conference in Amsterdam, says drug-resistant cases have recently increased by 50 percent in Denmark and Germany. While the total number of cases was small, and most of those analyzed were resistant to only one of the five most common drugs, doctors at the conference say the trend is alarming.  ‘‘It’s a message — ‘Watch out guys, this is serious,’’’ said Dr. Marcos Espinal, the lead author of the report. ‘‘It’s a potential major crisis in the future.’’
 In other parts of the globe, from China to Siberia to Puerto Rico, strains resistant to at least four of the five common drugs have emerged. Some cases are fatal; others are curable only at 100 times the cost of standard TB treatment. In Western Europe or the United States, where some cases of multiple-drug-resistant tuberculosis surfaced earlier, the cost of curing one can be as high as $250,000, counting $10,000 worth of drugs plus lengthy hospitalization, lab work, outpatient care and possible lung surgery.

 Tuberculosis, one of the world’s leading killers during the 18th and 19th centuries when it was called consumption, was nearly conquered after World War II by the discovery of antibiotics. But in the last decade, largely because of AIDS, it has re-emerged as one of the world’s most devastating diseases.
 Eight million people are newly infected each year, and 2 million people die.  Unlike malaria, which follows mosquito vectors, or AIDS, which spreads by sexual or blood contact, TB can circle the world at the speed of a passenger jet and be transmitted by a single cough. Health officials are seeking $700 million to attack the disease in poor countries.  They are in the awkward position of trying to raise the alarm in rich countries that don’t feel very threatened. At present, tuberculosis usually remains dormant in healthy people; only about 2 percent of them will progress toward the telltale sign — coughing up blood. Most cases in America and Western Europe occur among poor recent immigrants, or among AIDS patients, cancer patients, drug addicts and others with suppressed immune systems.  The United States recently doubled foreign aid grants for TB control, to $22 million. It also spends $100 million a year overseas to fight AIDS, a major underlying factor.
 But the international medical community’s most powerful weapon for raising money is the fear that an explosion of cases in the Third World will let divergent strains merge into something incurable and highly contagious that will attack the West.
 Warnings have already been sounded: In the early 1990s, a multiple-drug-resistant strain killed about 500 people in New York City — most AIDS-infected —and cost $1 billion to suppress. In 1997 a rural area on the Kentucky-Tennessee border fell prey to a contagious, rapidly growing strain that, luckily, succumbed quickly to standard drugs.  The emergence of drug-resistant strains in Germany and Denmark is seen as another possible harbinger of a Western epidemic echoing the one sweeping
through Africa and Asia. Denmark has had only about 500 TB cases; they were analyzed for resistance to standard antibiotics and were generally found not to resist more than one strain. Germany has had 10,000 cases, but fewer than 2,000 were analyzed. What surprised experts was that a small problem had grown by 50 percent in three years.
 In each country, about a third of the cases were among native-born Danes and Germans; two-thirds were among immigrants, most from Eastern Europe, a few from Africa.  Tuberculosis experts fear a backlash against immigration but say that would be a mistake.
 ‘‘People have this notion that you can wall off your borders from germs,’’ said Kraig Klaudt, a spokesman for the World Health Organization. ‘‘You can’t.’’  Espinal said, ‘‘No screening tools we have will catch the whole problem in refugees, tourists, workers and everyone else.’’ His solution: ‘‘to help those countries where the situation is so terrible.’’
 The report on multiple drug resistance being released Friday, International TB Day, does not cover the whole world, but 72 ‘‘geographical settings’’ — sometimes a whole country, sometimes just a province — with about 68,000 patients whose sputum samples were tested in sophisticated medical
laboratories.  Researchers found nine particularly worrying ‘‘hot spots’’ — places where more than 3 percent of patients seeking treatment for the first time already had drug-resistant tuberculosis. The nine were in seven countries: Estonia, Latvia, Russia, China, India, Iran and Mozambique.

NYT-03-23-00 2123EST