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Lisa Loving of The Skanner
Published: 12 November 2008

King County health officials are reporting the highest spike in tuberculosis cases in 30 years – even as budget cuts are set to slash their ability to treat the disease.
The county's annual tuberculosis report, released last week, shows 161 people were found with active tuberculosis cases in 2007, an 11 percent increase from the year before. 
The report indicates that Black residents are disproportionately affected.
"A lot of people think TB is a thing of the past but it's a thing of the present," said Dorothy Gibson, who is manager of King County's tuberculosis control program. "Our budgets are decreasing, the cost of doing business is increasing, our cases are going up but the budget is going down."
"I wouldn't use the term skyrocket," he said. "If you look at the cases per hundred thousand, there has been some slight increase, but King County has a more significant increase."
The department counts immigrants and native-born Black residents in the same category for the purposes of tracking tuberculosis rates.
"Last year the rate among the Blacks or African Americans was much higher than Whites," said Dr. Masa Narita, King County's tuberculosis control officer. The White population had 2.3 cases per 100,000, Black or African American, 46.2 cases per 100,000.
The report also showed Asians with a rate of 30.2 per 100,000, and Hispanics at 17 per 100,000.
"We've been raising concerns about increasing cases of TB and the TB is related to the racial disparity as well," Narita said. "Our challenges include a high proportion of people who live under the poverty threshold, people from increasingly diverse backgrounds, and the transient and migrating nature of many individuals at high risk for TB."
Gibson and Narita said the current plan for countywide budget cuts would require the elimination of eight full-time staff positions — 20 percent of their staff. "At this point we really have to work very efficiently in a very smart way," Narita said.
Narita says part of the reason for the upturn in tuberculosis and latent tuberculosis cases is that King County's population is increasing. "So even though the rate may be somewhat steady, you see a growth in the number of TB cases," he said.
Around the world, he said, about eight million people are diagnosed with tuberculosis a year; of those 2 million die.
Health officials say the budget cuts will hurt their ability to address outbreaks of the disease by cutting staff for the satellite tuberculosis clinic serving the homeless; hamper their ability to investigate the scope of potential tuberculosis exposures; and make it harder to make sure those diagnosed with active cases effectively complete their treatment.
King County Executive Ron Sims has proposed placing the department's most critical funding cuts in a " funding lifeboat" until June 2009. In the meantime, officials hope the state legislature will find funding for their programs.
"It's such a dire budget picture that we will have to take some cuts," Gibson said. "And there are cuts that are above the threshold and there are some cuts that are below a threshold. That means the cuts below the threshold that they have established for the lifeboat, those cuts mean that we would have to do our work differently."
Tuberculosis is an infectious disease caused by the tuberculosis bacteria, and is usually curable.
Narita said the disease comes in two phases: patients with active tuberculosis are stricken by active tuberculosis bacteria. People with dormant, or latent, infections are not sick because the germ is inactive; they cannot infect others.
Experts say there are no effective preventive medications nor is there an effective vaccine against the disease.

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