JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.

JAMA NEWS RELEASES
(Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005)

JAMA NEWS RELEASES

   MULTI-DRUG RESISTANT TB PERSISTS IN CALIFORNIA

   TREATMENT HELPS IN PREVENTING TB AMONG THOSE AT HIGH RISK

   CHEST X-RAYS NOT EFFECTIVE IN DETERMINING WHEN TB ACQUIRED

   GOALS FOR TB CONTROL REACHABLE FOR MOST OF WORLD

   RISK FACTORS FOR TUBERCULOSIS AND HOMELESSNESS OFTEN OVERLAP IN U.S.

   JAMA EDITORIAL: TUBERCULOSIS — A GLOBAL PROBLEM

JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)

   VIDEO: Windows Media | Quicktime

   MULTIDRUG RESISTANT TUBERCULOSIS STILL SIGNIFICANT PROBLEM

INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.

TV Note: This week's JAMA video news release is on multi-drug resistance among persons with TB in California. The release will be fed Tuesday, June 7, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).

JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE

Go to www.jamamedia.org for more information and to apply for access.

Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org

Save The Date: JAMA will present new research from its theme issue on tuberculosis on Tuesday, June 7, from 10 a.m. - 12:15 p.m. at the National Press Club in Washington, D.C. A program is included at the end of this email. To register, go to www.jamamedia.org and click on Events, or call 312-464-JAMA (5262).

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Reuben M. Granich, M.D., M.P.H., call Jessica Frickey at 404-639-8895.

WASHINGTON, D.C.—Despite significant advances in reducing the number of cases of tuberculosis in California, the proportion of multi-drug resistant cases has not decreased but remains steady, according to a study in the June 8 issue of JAMA, a theme issue on tuberculosis.

Lead author Reuben M. Granich, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

The number of tuberculosis (TB) notified cases has decreased by 33 percent in California, from 1994 to 2003, according to background information in the article. TB nevertheless continues to have a substantial public health impact, leading to 233 deaths in 2003. California led the nation in 2003 in the number of cases. Additionally, cases of TB due to strains of Mycobacterium tuberculosis that are at least resistant to the mainstay first-line drugs isoniazid and rifampin (i.e., multidrug-resistant [MDR] strains) continue to appear in California despite high rates of treatment success. The emergence of these life-threatening, airborne strains, which require prolonged treatment for at least 18 months and exhibit higher rates of treatment failure and poorer outcomes, threatens the efficacy of TB control efforts.

Treatment of patients with drug resistance requires considerable expertise and resources; health care cost estimates for individual MDR TB patients in the United States range from $28,217 to $1,278,066. MDR TB has also been associated with serious sizeable hospital and community outbreaks in California and the greater United States.

Dr. Granich and colleagues analyzed drug susceptibility data in the California TB surveillance system to describe the magnitude, trends, geographic distribution, clinical characteristics, risk factors, and outcomes of drug-resistant TB cases to better understand the impact of resistance to multiple drugs on TB control in California and to plan public health interventions. The analysis included 38,291 TB cases reported from all 61 local health jurisdictions in California during 1994-2003. Multidrug-resistant TB was defined as resistance to at least isoniazid and rifampin.

Of 38,291 reported TB cases, 28,712 (75 percent) were tested for resistance to at least isoniazid and rifampin. The researchers found that of these, 407 MDR TB cases (1.4 percent) were reported from 38 of 61 California health jurisdictions (62 percent); the proportion of MDR-TB cases did not significantly change over the study period.

Cases of MDR TB were 7 times more likely to have reported previous treatment for TB compared with non-MDR TB cases. Of MDR TB cases with outcomes, 231 (67 percent) completed therapy, and those with MDR TB were significantly less likely to complete therapy than those without MDR TB. Further analysis identified previous TB diagnosis, positive results when examining sputum for the TB germ under a microscope, Asian/Pacific Islander ethnicity, time in the United States less than 5 years at the time of diagnosis, and outcomes of "died" and "moved" as factors associated with MDR TB.

"Our findings are of concern and suggest that the cases of MDR TB in California may have appeared for any of 3 reasons: importation of MDR strains from outside the state, endogenous development of MDR strains due to inadequate case management or poor treatment within California, or ongoing transmission," the authors write.

The researchers found that MDR TB was strongly associated with birth outside the United States: 83 percent of MDR TB cases were foreign born, from 30 different countries.

"The findings of our study have several clear implications for TB control efforts. First, the fact that the majority of MDR TB cases were foreign born highlights both the importance of international TB control (prevention of MDR development and transmission abroad) as well as the need to expand overseas screening programs to encompass additional high-risk groups, coupled with measures to ensure timely detection and treatment of MDR TB once it develops. Second, our results suggest that adherence to recommended TB treatment guidelines must be improved to ensure that poor case management does not contribute to further cases of MDR within California.

"Third, the higher proportion of individuals moving or lost to follow-up, as well as the longer time to culture conversion and clinical characteristics favoring transmission, suggest that measures to reduce transmission and improve outcomes are also necessary. Fourth, additional resources (e.g., additional staff, regional centers of excellence, and 'warm lines' that provide clinical consultations) are needed because an increasingly large proportion of MDR cases appear to be arising in rural or smaller health jurisdictions with limited resources and expertise; the threat of MDR TB is exacerbated by a shrinking pool of clinicians experienced in managing these complex patients, who require intensive monitoring (e.g., drug levels, second-line drug susceptibilities, and renal function) over an 18- to 24-month period," the authors write.

The researchers add that to help support the efforts of local programs to manage patients with complex MDR- TB, the California Department of Health Services TB Control Branch established an MDR- TB clinical service that provides clinical support, collaborates with model centers, and will participate in the efforts of the Centers for Disease Control and Prevention to support several TB consultation medical training centers. "Our study suggests that clinicians should consider MDR TB in younger persons with TB who are Asian and/or Pacific Islander, non-U.S.-born from countries with known MDR TB epidemics, recent arrivals (less than 5 years) in the United States, and those reporting prior TB treatment."

"Multidrug-resistant TB requires complex management decisions, and additional resources will be required to successfully interrupt transmission and cure patients through timely diagnosis, treatment with adequate drug regimens and DOT, and through a patient-centered approach to ensure adherence. Although MDR TB may be curable at a great individual and societal cost, the implementation of both local and global TB control strategies is needed to prevent the further development and spread of MDR TB," the researchers conclude.
(JAMA. 2005;293:2732-2739. Available post-embargo at jama.com)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Alison D. Grant, M.B.B.S., Ph.D., email: alison.grant{at}lshtm.ac.uk or call 44-20-7927-2304.

TREATMENT HELPS IN PREVENTING TB AMONG THOSE AT HIGH RISK

WASHINGTON, D.C.—The drug isoniazid reduced the incidence of tuberculosis among HIV-infected miners in South Africa, a population at high risk of TB, according to a study in the June 8 issue of JAMA, a theme issue on tuberculosis.

Lead author Alison D. Grant, M.B.B.S., Ph.D., of the London School of Hygiene and Tropical Medicine, London, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

A major consequence of the human immunodeficiency virus (HIV) epidemic in developing countries is the increasing incidence of tuberculosis (TB), according to background information in the article. The cornerstone of TB control programs is the World Health Organization (WHO) strategy known as DOTS (directly observed therapy, short course), which may be effective in controlling drug resistance but has not prevented rising TB incidence in regions with high HIV prevalence.

The impact of HIV on TB is illustrated by data from gold mines in South Africa, where overall TB incidence now exceeds 4,000 per 100,000 population per year (i.e., 4 percent). Tuberculosis incidence was already high in this setting before the spread of HIV infection, largely because of a high prevalence of silica dust exposure. Rising HIV prevalence has resulted in increasing TB incidence, despite well-implemented TB control programs. Additional interventions are required to reverse the rise of TB in such settings.

In collaboration with the mining health service, the study team established a clinic for HIV-infected employees in a gold mining company in South Africa in 1999 to provide specialist care for HIV-infected employees, including preventive therapy (isoniazid and cotrimoxazole). This study evaluates the effect of this intervention. The authors analyzed 1,655 HIV-infected males (median age, 37 years) attending the clinic between 1999 and 2001 (before antiretroviral therapy was available). Median follow-up was 22.1 months. Employees were invited in random sequence to attend a workplace HIV clinic. Isoniazid, 300 mg/d, was self-administered for 6 months among attendees with no evidence of active tuberculosis.

A total of 1,016 of 1,655 men included in the analysis attended the clinic at least once. Six hundred seventy-nine (97 percent) of 702 men eligible to start primary isoniazid preventive therapy did so. The researchers found that the tuberculosis incidence rate before vs. after clinic enrollment was 11.9 vs. 9.0 per 100 person-years, respectively (incidence rate ratio [IRR] after adjustment for calendar period, 0.68 [32 percent reduced incidence]). In further analysis adjusting for calendar period, age, and silicosis grade, the tuberculosis IRR for clinic enrollment was 0.62 (38 percent reduced incidence). In analysis excluding individuals with a history of tuberculosis (and, hence, ineligible for isoniazid preventive therapy), the adjusted IRR for clinic enrollment was 0.54 (46 percent reduced incidence).

"Despite our intervention, the TB incidence rate in the postclinic phase remained unacceptably high at 9 per 100 person-years," the authors write.

"Additional interventions such as secondary preventive therapy and antiretroviral therapy [which is now being rolled out among the workforce] are required to reduce the very high residual morbidity attributable to TB in this community. Further work is needed to determine how best to use available interventions to minimize TB morbidity in areas where both HIV and TB are highly prevalent," the researchers conclude.
(JAMA. 2005;293:2719-2725. Available post-embargo at jama.com)

Editor's Note: This study was funded by Anglogold PTY Ltd. Dr. Grant is supported by a U.K. Department of Health Public Health Career Scientist award. Co-author Dr. Corbett is supported by a Wellcome Trust Career Development Fellowship. Co-author Dr. Chaisson is supported by a National Institutes of Health grant.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Neil W. Schluger, M.D., call 212-305-4904.

CHEST X-RAYS NOT EFFECTIVE IN DETERMINING WHEN TB ACQUIRED

WASHINGTON, D.C.—There is little correlation between the appearance of tuberculosis on chest x-rays and how recently the disease was acquired, according to a study in the June 8 issue of JAMA, a theme issue on tuberculosis.

Co-author Neil W. Schluger, M.D., of Columbia University, New York, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

Traditionally, active tuberculosis (TB) disease has been classified as either primary or secondary, reflecting the time between initial infection with Mycobacterium tuberculosis (MTB) and the onset of clinical disease, according to background information in the article. That interval can range over many years. Primary and secondary TB are also thought to have different characteristic radiographic (x-ray) and clinical features, though these clinical observations have been based on studies conducted before the availability of molecular fingerprinting techniques for TB. Molecular (DNA) fingerprinting, also known as restriction fragment length polymorphism (RFLP) analysis is a method for comparing strains of MTB from individual patients on a genetic basis. These techniques allow comparison of patients who have recently acquired tuberculosis to those whose tuberculosis was acquired long ago.

The researchers in this study used molecular fingerprinting and conventional epidemiology to test whether recently transmitted cases have radiographic features distinct from distantly acquired infection and secondly, whether the atypical features of the radiograph in HIV-associated TB are due to recent infection or are manifestations of altered immunity in the reactivation of latent infection. The study included 546 patients treated at a New York City medical center between 1990 and 1999. Eligible patients had to have had at least 1 positive respiratory culture for Mycobacterium tuberculosis and available radiographic data.

The researchers found that in "...clinically well-defined patients with TB that the most significant independent predictor of radiographic appearance is HIV status," the authors write. "The altered radiographic appearance of pulmonary tuberculosis in HIV is due to altered immunity rather than recent acquisition of infection and progression to active disease."

Although a clustered fingerprint (a DNA fingerprint from an MTB strain from one patient which has an exact match with an MTB strain recovered from at least one other patient), representing recently acquired disease, was associated with typical radiograph, the association was lost when adjusted for HIV status.

"In summary our findings argue that the terms primary and reactivation TB are misleading when used to make inferences linking radiographic findings to epidemiologic characteristics of patients. Radiographic findings have implications regarding host immune status of patients, but whether a patient's disease is due to recently transmitted or remotely acquired infection cannot be determined from them," the authors conclude.
(JAMA. 2005;293:2740-2745. Available post-embargo at jama.com)

Editor's Note: Supported in part by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Christopher Dye, D.Phil., email: dyec{at}who.int or call 41-22-791-2904.

GOALS FOR TB CONTROL REACHABLE FOR MOST OF WORLD

WASHINGTON, D.C.—International goals for reducing the number of tuberculosis cases and deaths to a certain number by the year 2015 can be achieved, but African and Eastern European countries could pose the greatest challenges, according to a study in the June 8 issue of JAMA, a theme issue on tuberculosis.

Lead author Christopher Dye, D.Phil., from the World Health Organization, Geneva, Switzerland, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

In 1991, it was estimated that eight million people developed tuberculosis (TB) each year and that several million people die from the disease, according to background information in the article. In response to this, the World Health Assembly of the World Health Organization (WHO) set 2 targets for TB control: to detect 70 percent of new cases and to successfully treat 85 percent of these cases.

Dye and colleagues conducted a study to determine if these goals will be met in 2005, as well as the goal of halving TB prevalence and deaths globally between 1990 and 2015. The researchers used data from DOTS (initially an acronym referring to directly observed treatment and now the term used for the WHO-recommended approach to TB control that includes five essential elements) and non-DOTS programs reported annually to the WHO by up to 200 countries, which includes the information needed to assess TB incidence, prevalence and deaths statistics. The elements of DOTS include political commitment; TB detection by sputum smear; standardized drug treatment (including directly observed therapy); a system to ensure regular drug supplies; and a standard reporting system, including treatment outcomes evaluation. Countries were grouped into nine different regions: African countries with a high HIV infection rate (four percent or greater in adults), African countries with a low HIV infection rate (less than four percent), Central Europe, Eastern Europe, Eastern Mediterranean, industrialized countries, Latin America, Southeast Asia, and Western Pacific.

Many countries began using DOTS and other TB control programs in the 1990s. The researchers found that the number of new TB cases increased globally in 2003 by about 1 percent, although new cases, total cases, and death rates were approximately stable or decreased in seven of the nine regions. The exceptions were regions of Africa with low (less than 4 percent in adults 15-49 years) and high rates (4 percent or greater) of HIV infection. Detection of new smear-positive cases by DOTS programs increased from 11 percent in 1995 to 45 percent in 2003 (with the lowest case-detection rates in Eastern Europe and the highest rates in the Western Pacific) and could reach 60 percent by 2005. More than 17 million patients were treated in DOTS programs between 1994 and 2003, with overall treatment success rates more than 80 percent since 1998. The overall treatment success rate was 82 percent in 2003, with variation among regions. The highest rates were reported in the Western Pacific region at 89 percent, with the lowest rates in African countries with high and low HIV infection rates (71 percent and 74 percent, respectively), in industrialized countries (77 percent), and in Eastern Europe (75 percent).

To halve the prevalence rate by 2015, TB control programs must reach global targets for detection (70 percent) and treatment success (85 percent) and also reduce the incidence rate by at least 2 percent annually. To halve the death rate, incidence must decrease more steeply, by at least 5 percent to 6 percent annually, the researchers write.

"Although the global incidence rate of TB was, in our assessment, still increasing slowly in 2003 (about 1 percent per year), this increase could be reversed by further reductions in transmission in high-burden countries," the authors write.

They add that the difficulties of managing TB in Africa and Eastern Europe are closely linked to HIV/AIDS and drug resistance, and specific solutions will be needed for these problems in these regions.

The authors write that the vigorous implementation of an enhanced strategy for TB control, bringing in new technology and a greater diversity of clinicians and other health care workers, should give most countries the momentum needed to reach the [United Nation's] Millennium Development Goals by 2015. "The mission to control tuberculosis in African and Eastern Europe will be more challenging, but until that task has been accomplished, TB will remain a major concern for public health worldwide."
(JAMA. 2005;293:2767-2775. Available post-embargo at jama.com)

Editor's Note: This work was funded by the World Health Organization.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Maryam B. Haddad, M.S.N., M.P.H., F.N.P., call Jessica Frickey at 404-639-8895.

RISK FACTORS FOR TUBERCULOSIS AND HOMELESSNESS OFTEN OVERLAP IN U.S.

CHICAGO—Risk factors for tuberculosis in the United States overlap with many of the risk factors associated with persistent homelessness, including being male or having a history of incarceration or substance abuse, according to a report in the June 8 issue of JAMA, a theme issue on tuberculosis.

"Homelessness is associated with an increased risk of exposure to Mycobacterium tuberculosis, undetected and untreated infection, and subsequent progression to TB disease," according to background information in the article. "In 1993, the Centers for Disease Control and Prevention (CDC) standardized national monitoring of TB disease among homeless persons by asking health departments to indicate whether annually reported TB cases occurred in homeless persons," the authors note. "Thus, 1994 through 2003 represents the first full decade of national TB surveillance that includes an assessment of homelessness."

Maryam B. Haddad, M.S.N., M.P.H., F.N.P., and colleagues from the CDC's Division of Tuberculosis Elimination, analyzed data of all verified TB cases reported into the National TB Surveillance System from 50 states and the District of Columbia from 1994 through 2003 to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB.

The authors note that because the U.S. Census Bureau does not have data on the number of homeless people in the United States they were unable to use the surveillance data to determine rates of TB disease among the homeless and instead calculated the proportion of all reported TB cases that occurred in homeless persons.

"Of 185,870 cases of TB disease reported between 1994 and 2003, 11,369 were among persons classified as homeless during the 12 months before diagnosis," the authors report. "The annual proportion of cases associated with homelessness was stable (6.1 percent - 6.7 percent)." The authors found a higher proportion of TB cases associated with homelessness in western and some southern states. "Most homeless persons with TB were male (87 percent) and aged 30 to 59 years. Black individuals represented the highest proportion of TB cases among the homeless and nonhomeless. The proportion of homeless persons with TB who were born outside the United States (18 percent) was lower than that for nonhomeless persons with TB (44 percent). At the time of TB diagnosis, nine percent of homeless persons were incarcerated." The authors continue, "Compared with nonhomeless persons, homeless persons with TB had a higher prevalence of substance use (54 percent alcohol abuse, 29.5 percent noninjected drug use, and 14 percent injected drug use), and 34 percent of those tested had coinfection with human immunodeficiency virus." Most of the TB cases in homeless persons were managed by health departments (81 percent) and 86 percent of those cases used directly observed therapy where healthcare professionals watched the patients take their medications.

"The most urgent priority for controlling TB in the United States is interrupting new transmission of M tuberculosis. Opportunities for transmission arise when homeless persons with infectious TB frequent homeless shelters, emergency departments, and jails," the authors write. "Once diagnosed, however, homeless TB patients received good case management, including laboratory diagnostic evaluation, appropriate use of a 4-drug regimen, and excellent treatment outcomes for persons given DOT [directly observed therapy] (recommended for all TB patients). Controlling this public health problem demands considerable resources but is integral to responding to the Institute of Medicine's call to eliminate TB in the United States," the authors conclude.
(JAMA. 2005;293:2762-2766. Available post-embargo at jama.com)

Editor's Note: Please see the JAMA study for funding information.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

Special Embargo for Release: 10 a.m. ET, Tuesday, June 7, 2005
Media Advisory: To contact Catherine D. DeAngelis, M.D., M.P.H., or Annette Flanagin, R.N., M.A., call Jann Ingmire at 312-464-2499.

JAMA EDITORIAL: TUBERCULOSIS — A GLOBAL PROBLEM

CHICAGO—In an editorial for the June 8, 2005 JAMA theme issue on tuberculosis, JAMA's Editor-in-Chief, Catherine D. DeAngelis, M.D., M.P.H., and Managing Deputy Editor Annette Flanagin, R.N., M.A., write, "Some developed countries, such as the United States, have had declining numbers of individuals infected with TB over the past decade, but 23 countries account for 80 percent of all new TB cases, with more than half concentrated in 5 countries (Bangladesh, China, India, Indonesia, and Nigeria). Most new cases in the United States, and probably a substantial proportion of new cases in other developed countries, occur among individuals born in other countries. Clearly, TB is a global health problem."

"The articles in this theme issue of JAMA devoted to TB address a number of important concerns including screening; treatment for active and latent infections; multidrug-resistant strains; and improving screening, treatment, and quality of care for all vulnerable populations. These are serious problems that must be solved before TB can be controlled."

"We hope that the insight provided by the various articles in this issue of JAMA will stimulate more interest in better funding for research on the prevention, screening, and treatment of TB and more initiatives to use current knowledge to improve access to appropriate and effective care and thereby successfully control TB. Clearly, it will take the will and resources of the entire world to eradicate this global problem."
(JAMA. 2005;293:2793-2794. Available post-embargo at jama.com)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

Go back to the top.

JAMA REPORTS

VIDEO: Windows Media | Quicktime

MULTIDRUG RESISTANT TUBERCULOSIS STILL SIGNIFICANT PROBLEM

VIDEO:
NAT SOT UP FULL FOR :04
Dr. Corder looking over x-rays on light board

AUDIO:
“These are the lesions here, these are actual infective areas in the chest.”

VIDEO:
B-ROLL
Dr.Corder continuing to look at x-rays

AUDIO:
THESE ARE X-RAYS FROM TUBERCULOSIS PATIENTS. TB IS GENERALLY TREATABLE WITH MEDICATION, BUT THESE PATIENTS HAVE MULTIDRUG RESISTANT TUBERCULOSIS, WHICH IS MORE SERIOUS AND VERY DIFFICULT TO TREAT.

VIDEO:
SOT/FULL
@ :16
Super: Reuben Granich, M.D., M.P.H.
Centers for Disease Control and Prevention
Runs :18

AUDIO:
“You have an 18 to 24 month treatment with multiple drugs that can be toxic at times, and also it’s very expensive, so each case of multidrug resistant tuberculosis can actually sometimes end up costing over a million dollars to treat and control.”

VIDEO:
B-ROLL
GFX/COVER
Dr. Granich and colleagues going over data in conference room

AUDIO:
IN A STUDY PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, DR. REUBEN GRANICH AND COLLEAGUES FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION ANALYZED 38-THOUSAND TB CASES REPORTED IN CALIFORNIA OVER TEN YEARS. THEY FOUND THAT ONE-TO-TWO PERCENT OF THOSE CASES, FOUR-HUNDRED-SEVEN OF THEM, WERE MULTIDRUG RESISTANT.

VIDEO:
SOT/FULL
Reuben Granich, M.D., M.P.H.
Centers for Disease Control and Prevention
Runs :12

AUDIO:
“One to two percent seems like a very low percentage. However, you have to remember each one of those cases may be 100 times more complicated than a normal TB case.”

VIDEO:
B-ROLL
TB medications
Crowd shots/street scenes

AUDIO:
MULTIDRUG RESISTANCE MOST COMMONLY OCCURS WHEN A TUBERCULOSIS PATIENT DOESN’T COMPLETE OR GET ADEQUATE INITIAL DRUG THERAPY. OR, SOMEONE WITH MULTIDRUG RESISTANT TB CAN SPREAD IT THROUGH BREATHING AND COUGHING.

VIDEO:
SOT/FULL
Reuben Granich, M.D., M.P.H.
Centers for Disease Control and Prevention
Runs :14

AUDIO:
“Most drug resistant TB correlated with being younger and also being born overseas. And in fact, our multidrug resistant TB cases came from over 30 countries, which further argues for the need for better TB control overseas.”

VIDEO:
B-ROLL
Woman receiving TB skin test

AUDIO:
DR. GRANICH SAYS THE BEST WAY TO PREVENT MULTIDRUG RESISTANCE IS TO TEST FOR AND THOROUGHLY TREAT TUBERCULOSIS WHEN IT FIRST OCCURS. AT THIS TB CLINIC, THEY ALSO USE SOMETHING CALLED DIRECTLY OBSERVED THERAPY.

VIDEO:
SOT/FULL
@ 1:42
Super: Frederick Corder, M.D.
Oversees TB clinic
Runs :08

AUDIO:
“Observing the patients and making certain that each day they get the correct medicine and they take it for the length of time that’s required.”

VIDEO:
B-ROLL
Dr. Corder looking at x-rays

AUDIO:
THAT’S ONE WAY TO PREVENT MULTIDRUG RESISTANT TUBERCULOSIS. THIS IS MAVIS PRALL WITH THE JAMA REPORT.