By Damian Gessler
National Center for Genome Resources
On March 24, 1882, Dr. Robert Koch announced his discovery of the bacterium Mycobacterium tuberculosis, the bacterium that causes tuberculosis. His achievement paved the way for our identification and treatment of infectious diseases today.
It is perhaps fitting that a disease that has caused so much devastation had such a hallowed role in modern medicine. TB has been with us since ancient times, rising to artistic immortality as the "consumption" of Puccini's Mimi in "La Boheme," while at the same time causing a total worldwide mortality of more than one billion people.
Koch's discovery is memorialized each year as World TB Day: a day to focus on the very real presence of tuberculosis.
This year in New Mexico we observe World TB Day with a special emphasis on how to bring 21st century technologies to this ancient scourge. The need for new approaches is evident in the fact that we have been diagnosing TB with the same tests for nearly a century, and no new TB drugs have been introduced in over 40 years.
How serious is tuberculosis? Current estimates are that two billion people— one third of the world's population— harbor the bacterium that causes the disease. There are 8 million new cases each year, causing 1-3 million deaths. This makes TB one of the top three infectious killers in the world, along with HIV/AIDS and malaria.
The good news is that U.S. cases have been steadily declining to a current level of about 13,000 patients per year. Yet complacency would be unwise.
Effective treatment of TB requires nearly daily contact with the patient for up to 18 months. Incomplete treatment results in the creation of a TB strain that is resistant to the drugs that were used, leaving a stronger TB bacterium.
Regular TB, while usually fatal if not treated, is eminently curable at a cost of about $8,000 per patient in the United States.
Multi-drug resistant TB (MDR-TB), on the other hand, costs around $200,000 per patient to treat. One case of MDR-TB can wreak havoc on an entire annual state health budget.
MDR-TB cases represent from 2 percent to 5 percent of all U.S. cases, yet are growing in incidence. Even worse, scientists, clinicians and public health professionals have recently found strains that are resistant to even MDR-treatment regimes. These strains, called XDR (for extensively drug resistant), are essentially untreatable by antimicrobial intervention.
Today— World TB Day— the University of New Mexico and the National Center for Genome Resources in Santa Fe will announce a paradigm-changing shift in how we combat tuberculosis. They will propose a National Tuberculosis Archive to be established here in New Mexico.
The Archive will be the nation's first comprehensive, integrated, biological and information resource for an infectious disease. The Archive will house a sample from every case of tuberculosis in the United States, giving us a complete, population-wide surveillance and base-line historical record. For each isolate it will record its genetic data, its "family tree," and its associated clinical and epidemiological data. This integrated information will be available to qualified personnel at any time for their use.
The Archive will bring a new level of on-demand, evidence-based decision making to national infectious disease preparedness and response. Such a wealth of new understanding will empower better and quicker diagnostics, new and shorter treatments, breakthroughs in new vaccines, and safer conditions for all of us. The Archive will put New Mexico at the center of the revolution in fighting TB.
Today, for much of the world, acquiring tuberculosis is as simple as breathing another person's sneeze. We are working for the day where the only place you will find tuberculosis is inside the freezers of the National Archive.
This commentary was endorsed by Dr. Gary Simpson, former state medical director of infectious diseases; Dr. Marcos Burgos of the Division of Infectious Diseases at the School of Medicine, University of New Mexico; UNM President David Schmidly; state Health Secretary Alfredo Vigil; and Robert Duncan, director of New Mexico Consortium's Institute for Advanced Studies.
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