TB is Taking Our Children: Is Washington Noticing?

It is in all of our interests to help stem an out-of-control TB epidemic -- from Washington to Cape Town -- and save the lives of children and adults.
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The world is rightly doing all it can now to fight the spread of H1N1 flu. I only wish it would do the same for tuberculosis.

My research at a clinical trial site outside Cape Town is finding TB infection rates of children at the highest levels ever recorded since the onset of TB chemotherapy in the middle of the last century.

By the time children enter school at age 5, 20 percent are already infected with TB. By the time they reach the age of sexual maturity, 13 years, 50 percent are infected. And between the ages of 24 and 28 -- the years of peak prevalence of HIV -- 80 percent are infected.

That's why what is happening in Washington now is so important to me, to all of those fighting TB in Africa, and really to all of us: No area of the world is immune from this contagious airborne infection, which passes on the wings of a sneeze or cough.

The Obama administration is working out its new Global Health Initiative, and we need help more than ever to fight this dual scourge of TB and HIV that is affecting children in my corner of the world from the day they are born.

These historically dangerous rates of TB infection bode ill for future TB control. While TB infections may remain dormant, certain triggers, such as HIV infection, awaken and launch TB microbes into destructive attacks on a person's body. When HIV and TB work in tandem, the result often is death.

My great fear is that if these unprecedented TB infection rates are not reduced, then TB control will fail for the next generation of Southern Africans. Even as efforts to fight AIDS have begun to make inroads -- the US government has been the world's most generous donor and implementer of these programs -- there is an urgent need to re-address TB control in Southern Africa where HIV has unmasked previously unrecognized high rates of TB transmission.

One major concern is that the increase of active TB cases is accompanied by the spread of multidrug-resistant TB (MDR-TB) and extremely drug-resistant TB (XDR-TB), strains of this ancient scourge that are very expensive and difficult to treat.

High TB infection rates occurring among children and adolescents many years before they arrive at clinics with clinical TB disease indicates that we need to develop new, broader approaches to TB control. Such a refocus will be important for policymakers as they reshape US global health programs in an increasingly difficult budget climate.

But developing-country doctors now worry that the US administration might pull back from the global AIDS battle and refocus on child and maternal health, neglected tropical diseases, and family planning.

While all those new efforts may yield benefits, they shouldn't come at the expense of the continuing AIDS and TB battle.

Wealthy nations need to lead the fight against this deadly threat, and the US can begin by fully funding its US global AIDS initiative, or PEPFAR, which Congress reauthorized in the summer of 2008. That called for spending $48 billion over five years on three diseases: $39 billion for HIV/AIDS, $4 billion for TB; and $5 billion for malaria.

Finding funds to deliver already proven methods of prevention and treatment is an essential part of the solution, but we also need more research and visionary leadership. My findings point toward a need for increased research of all the stages of TB development.

In Cape Town last year, we heard Dr. Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases (NIAID), deliver a blueprint for a global scientific research agenda to fight TB -- much like the world response to HIV two decades ago.

He is right. We need the fruits of a new global research campaign to find better diagnostic tools and better treatment for TB. We need to interrupt transmission TB at the infection stage, as well as treating the disease once it is ravaging a person's lungs. We are quietly desperate in South Africa, but now with the emergence of new leadership that marks the end of AIDS denialism, we are ready for a full partnership with the United States and other donor nations.

It is in all of our interests to help stem an out-of-control TB epidemic -- from Washington to Cape Town -- and save the lives of children and adults.

Dr. Robin Wood is a member of the Infectious Diseases Society of America and Director of the Desmond Tutu HIV Centre at the University of Cape Town.

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