Where TB's Danger Lies
Dormant disease. There's another way the United States is a sieve for TB: We import "latent" infection, a dormant form of the disease (which shows up with a simple skin test) in which the immune system keeps the microbe in check. Our immigration health screens don't target this or require treatment if it's discovered as they do for active TB, since it's not contagious. But 10 percent of latent disease becomes active and contagious, something that can be prevented by drug therapy. Randall Reves, medical director of the Denver Metro Tuberculosis Control Program, stresses that targeted testing of high-risk populations for latent TB, with mandatory treatment, is critical to wiping out the disease. The CDC agrees. So does the Institute of Medicine in its report "Ending Neglect." Ending neglect is a tall task calling for this and more: Better and faster diagnostic tests and treatment. Drugs to overcome resistance. An effective TB vaccine. Intense global efforts to stamp out TB in hot spots. And a major investment in America's own public-health system.
If a burst of public anger at one man with TB who boarded a plane against medical advice brings focus to these issues, that's a good thing. We may come to realize, as Reves suggests, that the public-health system's inability to better control the transmission of high-risk TB failed Speaker a lot more than he failed anyone else.
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