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Tuberculosis from Mycobacterium bovis in binational communities, United States

25 Jun 2008

Maria Victoria Valero

Source: Emerging Infectious Diseases (see original article)

Citation: Rodwell TC, Moore M, Moser KS, Brodine SK, Strathdee SA. Tuberculosis from Mycobacterium bovis in binational communities, United States (2008). Emerg Infect Dis; 14(6):909-16.

Around the world, every year, nine million cases and two million deaths occur as a result of tuberculosis (TB) caused by Mycobacterium tuberculosis. However, while M. bovis cases are also very common, their frequency and distribution are less studied. Most control efforts also are concentrated on M. tuberculosis. Enormous migratory movements, a feature of globalization, combined with the emergence and resistance of Mycobacterium species in both humans and animals, require careful reconsideration of policies on antibiotic use and patient surveillance (1,2). In addition, the great challenge is the early diagnosis and prompt treatment of infected people, before they develop the full-blown disease.

This retrospective study examines routine TB surveillance data from the San Diego area, California, between 1994 and 2005. The trends and risk factors related to M. bovis disease and deaths during treatment over the five-year period are analyzed. As the authors suggest, the epidemiology of TB is changing in the US. Multiple factors have been associated with this change. The highest frequencies of TB are concentrated in people born outside the USA.

The area selected – San Diego, California, together with its sister city Tijuana-Tecate, Mexico – represents 34% of the population living close to the border between the US and Mexico . In San Diego there was a steady increase in the Hispanic population from 20% to 29% during the period of the study. The results showed that incidence of M. bovis TB cases in San Diego County had increased at a rate of 4.1% per year. In contrast, TB incidence caused by M. tuberculosis declined during the same period. M. bovis cases were: ‘...concentrated in persons of Hispanic descent, especially those of Mexican origin and among those below 15 years of age, in whom M. bovis accounted for 45% of the culture-positive cases. The incidence of M. bovis TB is substantially higher than the national rate of 1.5% estimated from TB surveillance data but is similar to the proportional incidence (13%) among Mexican-born case-patients in New York, New York.’

The considerable incidence of M. bovis TB in children is a serious concern for animal and human public health programmes on both sides of the border. This is a good example of a situation where control strategies should no longer make a distinction between human and veterinary medicine. A ‘one health’ approach is required.

First, intensive action is required to detect and treat cases promptly. This will reduce the basic reproductive net or effective contact on genetic susceptible populations. Second, a combination of passive and active case detection is a prerequisite for monitoring the dynamics and trends of TB in human population but also for quality control of food for human consumption. Given that the evidence has shown a clear association of cultural and social determinants, most disease control activities should include information education communication (IEC) activities for these populations at the individual and community levels, and as part of food surveillance. Individuals must be made aware of the risk of M. bovis infection and sources of contamination. The community must be empowered to identify animals kept in poor sanitation conditions and to alert the health authorities.

Finally, health authorities should establish a sentinel surveillance system to detect new human TB cases and to test for the disease agent in food samples, in order to guarantee the quality of human dietary products. Cost-effective and combined methods and facilities for diagnosis should be employed at national and local health facilities.

Reference

1. Ellen M Zager and Ruth McNerney. Debate. Multidrug-resistant tuberculosis. BMC Infectious Diseases 2008, 8:10 doi:10.1186/1471-2334-8-10. This article is available from: http://www.biomedcentral.com/1471-2334/8/10

2. Cain KV and Mac Kenzie WR. Overcoming the Limits of Tuberculosis Prevention among Foreign-Born Individuals: Next Steps toward Eliminating Tuberculosis. Clin Infec Dis 2008;46:107–109

© 2008

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