With the recent news that there was a tuberculosis case affiliated with a school, the first reaction by most people is that they thought TB had been eliminated.
While the goal was to have it eliminated by 2000, this proved to be a little too optimistic as it did not account for the size of the issue globally, travel and heightened susceptibility of certain populations. In 2017 there were 10 million active cases world-wide which resulted in 1.6 million deaths.
Tuberculosis is an infectious disease caused by bacteria. It affects the lungs as well other body parts. Most people infected do not have symptoms — which is known as latent tuberculosis. Ten percent of the latent population will progress to active TB. The classic symptoms include a chronic cough with blood (think of Doc Holiday of Wyatt Earp fame), fever, night sweats and weight loss — the latter of which led to the disease often being called consumption.
Tuberculosis is spread through the air when people with active TB cough, spit, sneeze or speak. People who are latent cannot spread the disease. Smokers and people with compromised immune systems are more susceptible to acquiring it. The tuberculin skin test is used to screen people at high risk for TB. The Centers for Disease Control and Prevention stopped recommending testing for health-care workers in 2019 as they were not found to be at any more risk than the general population.
In North Carolina the top four counties for number of TB cases in 2018 were Mecklenburg, Wake, Guilford and Robeson. Robeson County easily has the highest rate, which occurs when the population is lower but the cases are high. Robeson County also differs in that our case population is not immigrants or homeless — shelters are notorious for creating an environment that allows transmission of the disease. Our infected population is one of us as they say. It is a unique strain here and CDC has identified it as being different than elsewhere. When cases are discovered, individuals are to provide a list of contacts, but we have found many people are less than forthcoming.
Still the number of contacts can make follow-up very time consuming. Nurses carry the medications to the infected individuals and ensure that it is taken. Everything about this program is very labor intensive.
Generally, Robeson County has 17 active cases of TB a year — half the counties in the state had zero. Our contiguous counties in 2018 were zero in Bladen; zero in Columbus; nine in Cumberland; one in Hoke; and zero in Scotland. As you can see we really are an outlier.
