For the past three decades, I have helped treat children infected with tuberculosis (TB) and have advocated for policy improvements nationally and internationally to prevent the disease. Soon, I will be working with the Centers for Disease Control and Prevention through an appointment on the Advisory Council for the Elimination of TB.
My priorities while working on the Advisory Council will be to maintain a focus on children, as well as drug development. Children with TB not only get sicker more quickly, but they are also much more difficult to diagnose. So it’s the worst of both worlds.
Traditionally, medications and the development of new therapies have only been studied in children after being licensed for adults. In fact, none of the TB drugs we use in Houston come in pediatric dosage forms. This is also true throughout the world. So, we crush up pills and make suspensions. Something I’m really going to push is the role of the industry in children’s medications. It’s important for kids’ safety to make sure we have the right doses in forms they can actually take.
Since the 90s, there have been a number of new technologies being developed, but one of the questions becomes who should have access to what developments. We’re working to find out what essential technology and equipment hospitals need, and what things should we be referring out to reference laboratories.
In the past 20 years a lot of work has been done related to infectious disease control and how to stop the spread of TB in facilities like hospitals and prisons. In the 90s, the big concern was catching TB on airplanes. By the way, you don’t catch TB on airplanes.
People always want to know how the Houston TB rates compare to the national rates. I always tell people there is good news and bad news; the bad news is we have enough TB in Houston that someone like me can actually build a career on it. The good news is we’ve knocked down the rates of TB in the city. TB disproportionately impacts folks in lower socioeconomic groups. The national rate is 3 per 100,000 persons. The rate in Houston is probably closer to 10 per 100,000. The Houston area has about 400 cases per year and somewhere around 8-10 percent of those cases are in children and adolescents.
Tuberculosis is a social disease with medical implications. The medicine is interesting, but dealing with the social issues is by far more difficult with a lot of these families. For many of our families, TB is just one of many problems they deal with.
Treatment for TB disease still requires someone to take 3 or 4 drugs for at least 6 months. The extended effort for treatment is even a problem for TB prevention. The traditional treatment for TB infection is 9 months of Isoniazid taken every day, a total of 270 doses.
For families without health insurance or a medical home, or for hourly wageworkers who are worried about their next meal or if they have a job, TB treatment can be terribly disruptive because the length of treatment is so long.
Fortunately, a new treatment for infection combines Isoniazid with another drug that patients only have to take once a week for 12 weeks; just 12 doses. We are figuring out the best way to use this new treatment and, so far, the results are very promising. We recently completed a study in Houston high schools showing we can educate the students, identify those with risk for TB infection, test them and complete the 12-dose therapy at school with a high level of success.