Health Matters: TB cases reawaken consciousness of disease in Grand ForksDr. Raymond Goldsteen answers the questions: "How has the tuberculosis outbreak affected Grand Forks?" and "Are there advances that still need to be made regarding TB?"
By: Raymond Goldsteen, Grand Forks Herald
Q. How has the tuberculosis outbreak affected Grand Forks?
A. In the past several months, an outbreak of tuberculosis in Grand Forks has created intense awareness of this disease. Sixteen cases of active TB have been diagnosed since October. Nine hundred people have been tested, many of them children in Winship, Valley and Phoenix schools. A few children have been removed from school until a physician clears them, a process that can take weeks.
However, we should consider our current interest in tuberculosis a reawakening. Tuberculosis was once much in the consciousness of Americans, including North Dakotans. The archives of the Grand Forks Herald contain numerous stories about tuberculosis from the early part of the 20th century, including one published 104 years ago nearly to the day.
On Feb. 7, 1909, the Herald reported on the testimony of Dr. G.F. Ruediger, director of the state public health laboratory at UND, and Public Health Officer Dr. James Grassick of Grand Forks before a joint assembly of the House and Senate in Bismarck about the problem of tuberculosis and the strides that had been made in treatment since the discovery by Robert Koch in 1881 of the tubercle bacillus.
Since 1909, many advancements in the diagnosis, treatment and prevention of TB have been made. In 1910, there were about 154 deaths from TB per every 100,000 residents in the United States, while today, there are only 0.2 deaths per 100,000.
Deaths from tuberculosis have declined as a result of a stronger health care infrastructure and improved standards of living. TB flourishes among people who live and work in airless, cramped conditions and are weakened by lack of nutritious food. Fewer people contract tuberculosis when living and working conditions are healthful. It is not coincidental that the origin of the Grand Forks tuberculosis outbreak is homelessness.
Q. Are there advances that still need to be made regarding TB?
A. Despite the success in reducing TB deaths in the United States and other industrialized countries, it’s still a major cause of death worldwide.
The World Health Organization reported TB remains one of the world’s top infectious killers. About 95 percent of TB deaths occur in low- and middle-income countries, which is no surprise since stopping TB is expensive and living conditions of people are worse in poor countries compared to richer ones.
The Grand Forks outbreak is an example of the low prevalence of tuberculosis among a generally well-nourished, well-housed population and application of the best public health practices for the rare occurrence of disease. Our public health infrastructure at the local, state and federal levels, as well as private health organizations, drew together and brought the outbreak to an end. However, as the world grows smaller, tuberculosis will surely remain in our consciousness, much as in the early 20th century, until its causes in poor standards of living are addressed and control measures are universally available for rare cases.
Goldsteen is director of the UND School of Medicine and Health Sciences Master of Public Health degree program, which is jointly offered with North Dakota State University. He has devoted most of his professional life to advancing public health and holds a doctorate in public health.
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