DeCock: “We dismiss routine TB control at our own peril”

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Kevin DeCock, MD (left), speaks to a colleague at the American Society of Tropical Medicine and Hygiene’s 59th Annual Meeting.

Kevin DeCock, MD, Director of the CDC’s Center for Global Health, has a lot on his plate these days. He oversees 900 people in CDC’s Atlanta headquarters and 1,500 people around the world. But he is not just monitoring efforts involving infectious diseases, he’s increasingly investigating ways to battle non-communicable diseases.

Still, with all of that, one of the things that worries him most is multi-drug resistant tuberculosis (MDR-TB).

In an interview at the American Society of Tropical Medicine and Hygiene’s 59th Annual Meeting, where 3,000 scientists and researchers this week are presenting and listening to cutting-edge findings in battling diseases, DeCock said he followed the recent comments made by Dr. Ezekiel “Zeke” Emanuel, a senior health advisor in the Office of Management and Budget, in Science Speaks on MDR-TB.

DeCock said he was glad Emanuel visited a TB hospital in Addis Ababa, Ethiopia, stating “I’ve been there as well.” When asked about the comments, DeCock said he did not want to react to them, but instead give his own view on next strategies to fight TB. Emanuel raised the ire of many global health activists when he noted in the interview that the cost of treating MDR-TB in a hospital was hugely expensive.

“Prevention – that’s the answer to TB,’’ DeCock said. “The answer to multi-drug resistant TB, and extensively drug-resistant TB (XDR-TB), is that you have to prevent it from happening. You need better infection control.”

The biggest danger in TB, he said, is if a country’s TB infection control program begins to fall apart, the disastrous results might not be apparent until a decade later, when a spike in TB cases emerges. Tuberculosis can remain latent for years in a person before becoming an active disease.

“If you mess up in TB control for even a few months, you will pay,’’ DeCock said. “We dismiss routine TB control at our own peril.”

As for some activists taking significant exception to Emanuel’s statements, DeCock said it would be good to have more public discussion on fighting TB.

“I think it’s good to discuss and debate these things,” DeCock said. “I really think that the issue of MDR-TB needs to be seen as a health security issue, where the worst case scenario will be that if we don’t control it, we’ll have another outbreak in New York or somewhere else [in the U.S.].”

From January 1991 through July 1992, MDR-TB was found in 43 of 193 TB patients in a New York City hospital. The estimated cost to stem the outbreak: $1 billion.

One thought on “DeCock: “We dismiss routine TB control at our own peril”

  1. Halim Danusantoso MD FCCP

    Indeed as de Kock has said correctly, prevention (P) is the clue to overcome MDR/XDR TB and that the human race has to pay immensely for any neglect in TB Control.

    P means that Doctors should and may NOT LOSE even a single case of TB under treatment. If the unfortunate Doctor is a single fighter, and this will happen if there is no (more) TB Control ‘serving unit’ (not to mention ‘TB Conterol Clinic’), then he or she will either cry seeing his/her TB patients being treated without organized supervision nor follow-up of the at-least 6 months long treatment. As long as TB cannot be totally cured with just several days of medications, any attempt to treat TB patients by a Doctor single-handedly may potentially create new MDR/XDR Tb cases.

    What then, if the Government cannot afford the existence of TB Control ‘serving units’/clinics.

    No need to panic! Let’s go back several decades and as History is the best teacher, we will see, that the community at large had intervened successfully through the action of Philanthropists and Volunteers to build Sanatoriums for TB patients almost everywhere without Government participation in the early years.

    Now Sanatoriums are not needed anymore, but small ‘serving units’ that can function properly can easily be started by the Community and kept functioning all the time, even allowing it to bloom to eventually tackle the not less serious TB-HIV tragedy all-together under one roof. But the most important thing is to start small and let growth happen by itself.

    (A recent example in this respect and details on how to prevent MDR-TB on a mini-scale in a TB Control Clinic for the Poor is available if regarded as necessary.)


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