TUBERCULOSIS: U.S./Mexico Border and Tuberculosis

Deborah Jackson-writer
The World Health Organization (WHO) estimates that between now and the year 20, nearly one billion people will be newly infected, 200 million will get sick and 70 million will die from TB if control is not strengthened.

According to the U.S. Centers for Disease Control and Prevention (CDC), TB has to be fought globally to protect locally. A report from CDC's Division of Tuberculosis Elimination states: "In an era marked by increased international travel and a global marketplace, no region of the world is immune from outside
influences. International collaboration will be essential to eliminate TB. TB does not stop at the U.S. border, and neither can prevention efforts."

Approximately 1 million persons cross the U.S.-Mexico border daily, with that large volume of influx there are three ways TB is being transmitted into the U.S.:
a) Persons with active TB disease move northward across the border
b) Persons with latent TB infection experience active disease after arrival in the United States
c) U.S. residents touring Mexico, including immigrants, acquire TB disease after returning to the United States (4-7). After a person with TB enters the United States, further transmission might occur, which contributes to TB morbidity in the United States directly from source patients and indirectly from their
contacts.

This could happen in the opposite direction also.
Of TB cases among Mexican-born persons, three fourths were reported from the four U.S. states bordering
Mexico: California, 820 cases; Texas, 364 cases; Arizona, 67 cases; and New Mexico, 17 cases.

The United States Agency for International Development (USAID) put $16 million into the TB fight along the U.S./Mexico border. Last year, $3 million facilitated bi-national information exchange systems in the border states. Another $13 million will be available between 2001 and 2004.

The international workgroup to combat TB along the U.S./Mexico border is named Ten Again TB and includes the 4 US border states: Arizona, California, New Mexico, and Texas and the six Mexican border states: Baja California, Chihuahua, Coahuila, Sonora, Nuevo Leon, and Tamaulipas. The goal is to
coordinate activities, authorities, resources and TB programs on both sides of the border.

One strategy used to try to prevent multidrug resistance tuberculosis (MDR-TB) from occurring is directly observed therapy or DOT. MDR-TB, which is, defined as the disease due to TB bacilli resistant to at least isoniazid and rifampicin---the two most powerful anti-TB drugs.

With DOT, an outreach or public health worker visits each patient to observe and record patients swallowing the full course of the correct dosage of anti-TB medicines (treatment lasts six to eight months). The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin, and ethambutol. These treatments may be anywhere from two to 10 times a week, for several months.

Project “Juntos” was the first binational TB program established 10 years ago by Texas Department of Health, CDC, Chihuahua Department of Health (Mexico), and supported by New Mexico DOH to reduce the incidence of TB in El Paso-Juarez-Las Cruces region.

http://www.cdc.gov/washington/legislative/09081999.htm
http://www.cdc.gov/nchstp/tb/faqs/qa.htm#Intro_1
http://www.ama-assn.org/special/hiv/library/readroom/jama98/71009t2.htm
http://www.ama-assn.org/special/hiv/library/readroom/jama98/jst71009.htm
http://www.who.int/gtb/publications/mdrtb/
http://www.nmsu.edu/~bec/tbontheborder.pdf