Tuberculosis levels drop to record low

MOUNT VERNON, Mo. -- The number of reported tuberculosis cases has dropped to a record low in Missouri, but officials warn that the disease has yet to be eradicated.

Missouri had 157 cases of TB in 2001, representing the lowest level since the state began keeping records in 1944. It also represents a 26 percent decrease from the 211 cases in 2000.

While the fight isn't over, the state's goal of eliminating TB by 2010 may not be realized.

"We cannot quit hammering it," said Ron Williams, director of the Missouri Rehabilitation Center in Mount Vernon, where the state operates a TB lab and treatment unit.

"Just as soon as you think you have got it under control, a new case emerges," he said. "The potential for a flare-up is always there."

One to two patients usually are in the nine-bed unit at any given time, and 30 to 40 patients are treated annually at the center in southwest Missouri. The center also is home to the state's lab for TB detection. Virtually all the state's sputum samples are analyzed there in a secure lab.

For those who are trying to control the disease, the problem is the reintroduction of the TB bacillus into areas that have been free of the disease or at least free of potential exposure.

An example is what happened last year at Branson. A high school student who was new to the school became ill. He was given a skin test for TB, and it was positive. A chest X-ray showed abnormalities.

"Those were the red flags," said Pam Priest, a nursing supervisor with the Taney County Health Department.

About 670 people at the high school were screened in June. They were rescreened 90 days later. In all, 2,500 screenings would be taken in the community. Action by the county health department contained the disease to the student.

"We tracked it down and found that he was exposed somewhere else before he moved to Missouri," Priest said. "What this means is that the disease can be active almost anywhere."

Linked to refugees

A significant number of Missouri's TB cases can be linked to refugees or immigrants who have come to this country, Williams said. The Bosnian refugees who live in the St. Louis area are an example. Several TB cases have been identified in that group.

Meanwhile, Vic Tomlinson, chief of the TB program for the Missouri Department of Health and Senior Services, said he's encouraged by the numbers.

"It's because a lot of people are working very hard -- nurses, outreach workers, local health departments, private physicians and homeless shelters -- to get the job done."