Keeping Tuberculosis at Bay in West Queens

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(West Queens has the highest tuberculosis prevalence rate in the Borough, at well over twice the city rate. Chart: Department Of Health and Mental Hygiene)

In West Queens, keeping tuberculosis infection rates under control is painstaking, but necessary work. At 18.9 per 100,000, the prevalence for the disease there is six times the national average, and over twice the citywide rate according to a recently published report by the Bureau for Tuberculosis Control (BTBC).

Tuberculosis, or TB, is an airborne respiratory disease, which can spread rapidly from the infected to relatives, colleagues and beyond, and is the number one cause of death among the HIV-positive population in the United States.

Screening for the disease, and ensuring that the infected follow their prescribed treatments are the two key measures that help keep infection rates down. This is necessary both for people with latent tuberculosis, meaning those who show no symptoms, as well as those who are actively ill.

“It’s difficult because I have to take time off work, and she has to take time off school,” said Gelek Gyaltsen as he waited for the results of his daughter’s most recent tests at the Corona Chest Center in Queens. “Hopefully this is the last one.”

Gyaltsen’s wife and two daughters recently joined him to start a new life in New York City. Gyaltsen is a Tibetan who immigrated to New York in 2008, but his family had stayed behind. They were allowed to move to the U.S. this year, but upon arrival, compulsory Green Card blood tests revealed one of Gyaltsen’s daughters had a latent tuberculosis infection. Because the family lives in West Queens, they were referred to the Corona Chest Center, one of the BTBC’s special tuberculosis clinics.

Gyaltsen’s daughter was immediately prescribed two drugs called Isoniazid and Rifapentine to suppress the infection. The newly approved cocktail allows for much faster treatment than Isoniazid alone, which requires patients to take one dose a day for nine months. Rifapentine treatment, which is three times faster, takes only twelve weeks.

Although shorter, this method still requires patients to show up for regular X-rays over the course of the therapy, and they are closely monitored to make sure they are following their prescribed treatment rigorously.

Not following through on treatment can result in the disease’s mutation into drug resistant strains. Cases like these require hospitalization, and take two years and sometimes over $1 million to cure for a single patient.

“A few cases of drug-resistant TB can really blow a whole program’s budget,” said Erica Lessem, an assistant director of Treatment Action Group’s TB/HIV Project. She added that drug-resistant tuberculosis is “a human made phenomenon that only revolves around the disease being treated inappropriately.”

West Queens is an area that data from the U.S. Census and the NYC Department of City Planning show is heavily populated by immigrants and non-proficient English speakers from China, and Central and South America, many of whom are reluctant to seek treatment for fear of deportation. In these conditions, it is particularly challenging for health workers to convince patients they do not risk deportation by seeking treatment and to prevent them from interrupting it once they take the first pill.

Legal status fears and language barriers aside, the fact that West Queens has a largely immigrant population is especially significant because most tuberculosis cases in the U.S. are brought in from foreign countries.

“What we think is going on is that people with latent TB infection come into the country, and 10% of them develop an active form of the disease,” said Neil Schluger, a professor of epidemiology at Columbia University. “Last year, 84% of active TB cases occurred in people who were born outside the U.S.”

The last serious epidemic of the disease in New York dates back to the 1990s, with rates of infection reaching 220 per 100,000 residents in some neighborhoods. That is almost identical to the World Health Organization’s 2012 prevalence for the disease in Ethiopia, one of the world’s poorest countries.

Since the outbreak, widespread outreach and preventive care efforts, including compulsory blood work for all Green Card recipients, as well as policies such as making it a legal requirement for medical personnel to report active tuberculosis cases, have reduced infection rates dramatically.

Perversely, the BTBC’s success in keeping tuberculosis incidence in New York under control has had the adverse effect of causing the State Department of Health and Mental Hygiene to steadily decrease the bureau’s budget. All three experts interviewed in this article agreed cutting down on screenings amounted to underestimating the risk the disease poses, and could lead to a repeat of the 1990s outbreak.