Breathe California Golden Gate has been fighting Tuberculosis (TB) since 1908. Founded as the San Francisco Association for the Study and Prevention of Tuberculosis, an independent, local nonprofit organization, our original mission was to fight the TB epidemic that accounted for 1 in 7 deaths in San Francisco at the beginning of the last century. By the 1930s, through education, advocacy, and research, our work had significantly helped reduce local TB rates by 60% –before the benefit of antibiotics or x-rays!
Tuberculosis is an airborne contagious disease caused by a strain of bacteria (Mycobacterium tuberculosis) and primarily affects the lungs. When a person with infectious TB spits, coughs, sneezes, speaks, or even sings, the disease spreads easily through the air in microscopic droplets. A skin or blood test will indicate TB infection. Symptoms progress slowly, making it very difficult to diagnose at early stages.
Tuberculosis manifests in two manners: latent TB infection and TB disease. People with latent TB are infected, but feel well, show no symptoms, and cannot transmit the disease to others. Without a TB diagnosis and effective proper treatment with antibiotics over a period of months, 5-10% of these cases will eventually develop TB disease, 50% within the first few years of initial infection. People with TB disease are considered infectious and may spread the disease to others. Symptoms may include a persistent cough, chest pain, coughing up blood, weight loss, lack of appetite, chills, fever, and night sweats. Suggested treatment includes a long course of several antibiotics.
Though TB rates have been greatly reduced, it continues to pose a threat today, especially with the advent of multiple drug-resistant tuberculosis (MDR-TB). TB is one of the top 10 causes of death worldwide. In 2015, over 10 million people contracted tuberculosis and nearly 2 million died from it, with 95% of the deaths occurring in lower- and middle-income countries. In 2015, California had the highest number of TB cases in the United States. Anyone can become infected with TB, but some people are more at risk than others, such as those living in crowded conditions, those who work with people who have TB, and those whose immune systems are compromised. For example, the risk of developing tuberculosis is over 30 times higher in people who have HIV. TB is a leading infectious killer of people living with HIV/AIDS, causing over 50 percent of AIDS deaths in some sub-Saharan African countries. To help raise awareness of the serious nature of TB; on March 24th, World TB Day, Breathe California marched down Market Street in San Francisco with our community partners.
One of Breathe California’s community partners, the California Tuberculosis Controllers Association (CTCA), is on the frontline, coordinating the fight against the spread of TB on a statewide level. CTCA Executive Administrator Judith Thigpen, MPH, explains the role her professional organization plays in eliminating TB in California: “The CTCA brings together public health doctors and nurses who are focused on tuberculosis control in their local health jurisdictions, so that policies and practices can be advanced in partnership with the state public health programs.” This is not the typical model in which the state determines local standards. “Here in California, it is a locally driven program” Thigpen says. “The local doctors and nurses are working together to advance practices and policies.”
Thigpen recently spoke with Breathe California about the newly formed TB Elimination Coalition created to “build bridges to eliminate TB, developing strong relationships with leadership in communities most affected by TB throughout California.” The coalition, of which Breathe California is a member, recognizes the need to identify and treat people with latent TB infection before they develop TB disease and spread it in their communities. Thigpen stresses the role of hearing the voices of people with TB as an important factor in fighting the disease. “There seems to be stigma connected to tuberculosis – a misconception that it is the fault of TB sufferers that they got TB or that it is a disease of poverty. Anybody can get TB. We are working to connect TB patients with each other to provide support as they get through long treatments, and to build a movement to advocate for better educational providers and for those at risk.”
Dr. Jerry Jew, M.D., is Medical Director at North East Medical Services (NEMS). A network of 10 clinics with over 60 health care providers based in San Francisco, NEMS is a non-profit organization and one of the largest community health centers in the United States specifically targeting the medically underserved Asian population. “TB is a global disease, much more prevalent in developing countries in Africa and Asia,” he explains. “A lot of my patients come from China and Asia, so being aware of TB and being able to treat patients properly is key not only to treating families, but our neighborhood and community.” Dr. Jew estimates that there are over 100 active cases of TB diagnosed in San Francisco annually. During our interview, Dr. Jew stressed the role of education in fighting the disease. “It’s good for us to learn about TB and to be tested, especially if we have the right risk factors, such as coming from areas of the world where TB is much more prominent, or having a family member who was infected with TB before. What you don’t know may hurt you, your family, and your community. We have to rise above the stereotypes and see TB for what it is: a treatable preventable disease.”
Breathe California began fighting this disease over 100 years ago so we asked Dr. Jew how long he thinks it will take to eradicate TB in San Francisco altogether? “There are so many factors that come into it,” says Dr. Jew. “Clinics, hospitals and health care systems like the San Francisco Department of Public Health and TB controllers are the ones that lead this process. My hope is as soon as possible!”
We have made significant progress since 1908 and in fact, there is a vaccine for TB. However, because it is not a very effective vaccine, it is not often used in the United States. Breathe California urges you to know your risk, get tested, educate your friends and family, and take precautions to prevent TB transmission – especially while traveling.
We are grateful to all the providers and public health professionals traveling to Atlanta to learn more about how to protect their communities from TB at the 2017 National TB Conference next week!