The latest tuberculosis outbreaks at schools in California and Kansas -- exposing hundreds of children and adults to a potentially fatal bacterial infection -- remind us that TB continues to pose a grave threat to the public’s health.

Current efforts focus predominantly on treating active TB disease, while allowing the source of that disease -- vast pools of TB infections that often lay dormant in the body for many years -- to perpetuate. This approach is like trying to drain the sink with the faucet still running.

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To defeat TB in the United States, public health officials must urgently expand screening and prevention efforts to stop TB in individuals before it progresses to become an active, contagious disease. TB is an airborne bacterial disease acquired by breathing. Without proper treatment, it can be fatal. More than 500 Americans still die of TB each year.

Inhaling TB bacteria does not immediately lead to serious illness. The human immune system usually surrounds and seals off the invading germs, preventing them from attacking the rest of the body. An infected person can host TB like this for years or even decades, exhibiting no outward symptoms.

About 11 million Americans -- one out of every twenty-five people -- are living with TB infection -- and that statistic varies dramatically among ethnic groups and income brackets. Each infected individual has a five-to-ten percent chance of their TB infection breaking free and
making the person seriously sick and contagious. That equates to up to a million new TB cases in future years. In 2014, just over 9,500 U.S. cases were reported nationwide.

Treating a TB infection versus the full-blown disease is dramatically less costly and complex. A simple test can identify an infection, which can usually be eliminated with a single, simple, three-month course of antibiotics. For someone who has progressed on to become an active case, treatment takes twice as long and requires four or more  different antibiotics. If drug resistance develops, treatment time jumps to 24 months and requires a potentially toxic cocktail of antibiotics -- typically with total cost topping $200,000.

The U.S. public health system devotes far too few resources to combating those early infections. It usually doesn’t kick into action until the active disease has surfaced and has turned dangerously communicable.

That disparity comes at a huge cost. In August 2013, an employee at a hospital in El Paso, Texas was diagnosed with active TB disease. Administrators quickly moved to screen nearly a thousand infants and several dozen staff members that had come through the facility. They had to track down families in four other states and Mexico. The entire process took over a year and cost over a quarter of a million dollars.

This time-consuming, expensive situation could have been avoided. That first hospital employee -- patient zero in this outbreak -- had tested positive for TB infection a decade prior. But that diagnosis had not been properly flagged and treated.

Health officials need to continue to identify and treat active cases, but also need to focus their attention on screening and treating TB infections. That’s the best way to prevent new cases and stamp out this dangerous disease.

The Centers for Disease Control and Prevention and the Department of Health and Human Services should partner up with and provide resources for local health departments and private health organizations to launch a public education campaign to raise awareness about TB
infections.

Federal officials have engaged in similar outreach efforts for major diseases such as Alzheimer’s and lead poisoning. They should replicate that model for TB.  Such outreach should focus on patient communities particularly vulnerable to infection, such as the homeless, professional healthcare workers, and people in the U.S. originally from countries with high TB rates.

This is not to stigmatize or fuel paranoia about these communities. Rather, every person has the right know if they’re living with TB infection. Proper education empowers vulnerable people to seek out diagnostic testing and take control of their health.

Indeed, in one Baltimore hospital study, fully 87 percent of immigrants that screened positive for TB got treated. And among those, over 90 percent completed the full antibiotic regimen, fully preventing disease progression. Interestingly, studies have shown that the foreign born are actually more likely than people born in the U.S. to complete this treatment.

In order to more accurately assess the burden of infection, the CDC should officially classify TB infection as a reportable health condition, just as active cases of the disease are currently reportable. This policy shift would improve the data on infection rates and help healthcare workers better target their testing.

And, finally, Congress needs to increase the research dollars flowing into the development of new TB diagnostics and treatments, with the ultimate goal of producing an effective vaccine.

TB has not yet been fully eliminated from American shores. By investing in prevention, however, health officials can bring down infection rates, empower millions to live TB-free lives, and potentially eradicate TB in this country.
 
Benjamin is chair of Stop TB USA.