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Retro Pestilence

Who can keep a secret? Hamilton County Public Health, for starters. And the front office at Mt. Healthy Schools. Late last fall, I e-mailed Mt. Healthy superintendent Lori Handler to check out a rumor about a case of tuberculosis in one of her schools. But Handler would only tell me that the district had cooperated with the health department in its investigation of an unnamed “contagious disease.” So I turned to Pat Allingham, Hamilton County Public Health’s director of disease prevention. Allingham said that there had been a school TB investigation. And no, she would not tell me where. But here’s what happened: A teenager at some local school was diagnosed with TB; his friends and classmates were screened. Three had positive skin tests, but not active TB. All were successfully treated. And now, “our work there is done,” says Allingham.

It’s always impressive when a public health crisis is averted before the public knows it exists. But it made me wonder: Was last year’s episode an anomaly, or is tuberculosis—the “white plague” of our great-grandparents’ day—creeping back?

Turns out there’s a reason that TB is barely a blip on the average person’s Health Anxiety radar screen. In 2012, the United States recorded the fewest cases since the nation started to keep track of such things in 1953. “Historic lows,” says Lisa Haglund, medical director for Hamilton County Tuberculosis Control. The county itself had only 12 cases in 2012, and when we spoke, was tracking about the same for 2013. “Hamilton County pretty much mimics the [trends] nationwide,” Haglund explains.

So it’s not creeping back. But that’s not to say it couldn’t. “The mandate is to eliminate tuberculosis,” says Allingham when I meet with her and Haglund at the county’s Tuberculosis Control Clinic, which is discreetly tucked into a separate wing of the Christ Hospital Health Network’s complex in Mt. Auburn.  But our increasingly global lives—and ironically, our success in treating other conditions—makes that difficult.

Here’s Tuberculosis 101: It’s caused by a bacterium that most often affects the lungs. It’s airborne; coughing, sneezing, and spitting spread it. Latent TB means you’ve been infected by the germ. You’re not ill and you can’t transmit it, but it could (and in about 10 percent of cases, it does) progress to active TB. Active TB means that the health department will get involved in your life. You’ll be isolated at home and someone will keep an eye on you while you’re taking treatment. Literally. “A nurse goes to the house and watches them swallow,” Allingham explains.

A century ago folks called it consumption—the slow, ceaseless grind of fever, coughing, and night sweats. It was the nation’s leading cause of death; at its worst, the city recorded more than 1,000 fatalities a year, and patients filled the sprawling hospital where Dunham Recreation Center now sits. That changed in the 1940s with the advent of antibiotics, and by the 1980s, says Haglund, “it was a disease of the elderly”—dwindling numbers of people infected in an earlier era.

But it’s one tough bug. The arrival of drug-resistant strains, the uptick in homelessness, and the development of a new at-risk population—people with HIV—sent TB cases surging in the ’90s. The U.S. responded aggressively, but many countries couldn’t. Today a third of the world’s population has latent TB, according to the World Health Organization, and foreign-born people account for about 60 percent of U.S. cases.

There are other factors. “Troops [can] come back from Iraq with it,” Allingham says. And medical advances—kidney transplants, chemotherapy, treatments for Crohn’s disease and rheumatoid arthritis—leave people more susceptible. So chances are the county’s TB clinic will not close anytime soon.

Allingham says there are plans for a new sign to mark the clinic—a sign that will only reference Hamilton County Public Health, not TB. Even so, there could be benefits to having the word out there. “Used to be a lot of us had grandparents who [knew] what TB was like,” she says. A gentle reminder can’t hurt.