Graphic by Jeremy Gordon.
A century on from the opening of the Pleasant Valley
Sanatorium, some say the threat of Tb still hangs over the
country.
A leading researcher believes both the World Health
Organisation and the New Zealand Government have got it wrong
over the disease, which still kills more than 2 million
people each year and has been targeted for elimination by
2050.
Prof Philip Hill believes the WHO's policies are flawed.
He also considers New Zealand's policy on testing and
treating Tb in immigrants is failing and that policy-makers
do not properly understand the biology of Tb. Mark Price
reports.
In Otago, you could be forgiven for thinking tuberculosis has
been beaten - gone like smallpox.
Just four cases have been confirmed in the past two years and
two cases are still awaiting results.
According to the Southern District Health Board, four of the
Otago cases involved "overseas residents" and that tallies
with a 2003 Ministry of Health statistic that 69% of Tb
patients in New Zealand were foreign-born.
Prof Philip Hill, director of the University of Otago's
Centre for International Health, has no issue with
immigrants, but he does have an issue with the way New
Zealand deals with those coming into the country who may be
carrying the disease.
He believes policy-makers have got it wrong and a major part
of the reason is they simply do not understand the term
"biphasic".
In relation to Tb, biphasic means there are two opportunities
for someone exposed to Tb to get the disease.
Having been coughed on by someone with Tb, about 5% of people
will get the disease in the following year or two.
But another 5% of those coughed on can carry the dormant Tb
bacillus for decades before suffering (activating) the
symptoms of disease.
Prof Hill says New Zealand's Tb-screening programme for
immigrants is not picking up this second group.
"They have an X-ray if they are positive (have been exposed
to Tb) and then, if that's clear of disease, they send them
into the community in New Zealand."
Eventually, Prof Hill says, a proportion of this group "start
coughing up Tb in New Zealand that they got from overseas" -
something that could be prevented using medicine at the early
stage.
"It's just silly. It's like the biphasic thing is beyond the
human ability to policy-make.
"They think of disease: you get exposed, you get disease or
not. They don't think of the fact that actually, with Tb it's
a biphasic thing, and we need to be thinking about it if we
want to control Tb coming into the country.
"We need to be giving prophylactic (preventive) treatment to
those who show evidence of infection from when they were
overseas."
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