There are many things plaguing the world today, one of them is Mycobacterium tuberculosis otherwise known as Tuberculosis (TB). Since it’s origin TB has become more virulent against antibiotics and became multi-drug resistant (MDR-TB). Two countries come to mind for comparison, China and the United States. China is having severe problems with the disease while the United States is managing it a bit better. Each country has unique circumstances and the statistics show that both may be doing better with just TB but MDR-TB is sticking around and gradually becoming more and more of an issue.https://scholarscompass.vcu.edu/uresposters/1067/thumbnail.jp

Healy, Megan K.

VCU Scholars Compass

Virginia Commonwealth University
VCU Scholars Compass
Undergraduate Research Posters Undergraduate Research Opportunities Program
2014
A Look at Tuberculosis and Multi-Drug Resistant
TB in the United States & China
Megan K. Healy
Virginia Commonwealth University
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Healy, Megan K., "A Look at Tuberculosis and Multi-Drug Resistant TB in the United States & China" (2014). Undergraduate Research
Posters. Poster 68.
https://scholarscompass.vcu.edu/uresposters/68
A Look at Tuberculosis and Multi-Drug Resistant TB !
in the United States & China!
Megan K. Healy!
Anthropology Major, School of World Studies!
Abstract:	  
There	  are	  many	  things	  plaguing	  the	  world	  today,	  one	  of	  them	  is	  Mycobacterium	  tuberculosis	  otherwise	  known	  as	  Tuberculosis	  (TB).	  Since	  it’s	  origin	  TB	  has	  become	  more	  virulent	  against	  anBbioBcs	  and	  became	  mulB-­‐drug	  resistant	  
(MDR-­‐TB).	  Two	  countries	  come	  to	  mind	  for	  comparison,	  China	  and	  the	  United	  States.	  China	  is	  having	  severe	  problems	  with	  the	  disease	  while	  the	  United	  States	  is	  managing	  it	  a	  bit	  beIer.	  Each	  country	  has	  unique	  circumstances	  and	  the	  
staBsBcs	  show	  that	  both	  may	  be	  doing	  beIer	  with	  just	  TB	  but	  MDR-­‐TB	  is	  sBcking	  around	  and	  gradually	  becoming	  more	  and	  more	  of	  an	  issue.	  	  
	  
	  
IntroducBon:	  
Every	  year	  there	  are	  millions	  of	  diagnosis’	  and	  
deaths	  due	  to	  the	  disease,	  Tuberculosis	  (TB)	  
("Tuberculosis	  Data	  and	  StaBsBcs.").	  Tuberculosis	  
caused	  by	  the	  bacteria,	  Mycobacterium	  tuberculosis,	  
is	  a	  pulmonary	  infecBon	  that	  can	  get	  into	  a	  person’s	  
lungs	  via	  the	  air,	  blood,	  or	  lymph.	  The	  bacterium	  
insBgates	  the	  lung	  to	  form	  “fibrous	  nodules	  called	  
tubercles”	  around	  the	  bacteria	  itself	  (Saladin	  888).	  
The	  main	  symptoms	  of	  TB	  include,	  coughing	  up	  
blood	  or	  sputum,	  chest	  pain,	  and	  coughing	  that	  gets	  
worse	  over	  three	  weeks	  (“Basic	  TB	  Facts”).	  The	  
control	  of	  this	  disease	  is	  made	  more	  difficult	  
because	  two	  of	  the	  three	  main	  symptoms	  are	  also	  
modes	  of	  transmission	  (See	  Image	  1).	  As	  of	  right	  
now	  there	  is	  a	  way	  to	  kill	  the	  bacteria	  in	  those	  who	  
are	  sick	  with	  many	  different	  lines	  of	  anBbioBcs.	  
What	  is	  happening,	  and	  has	  been	  developing	  is	  that	  
the	  TB	  bacterium	  is	  becoming	  resistant	  to	  
anBbioBcs.	  What	  this	  means	  is,	  that	  TB	  has	  become	  
mulB-­‐drug	  resistant	  (MDR)	  the	  first	  and	  second	  lines	  
of	  anBbioBcs	  used	  to	  treat	  TB,	  rifampin	  (RIF)	  and	  
isoniazid	  (INH)	  are	  ineffecBve	  to	  treat	  the	  disease	  
(Luo	  et	  al.).	  In	  most	  cases	  of	  TB	  these	  two	  drugs	  
work	  as	  long	  as	  the	  paBent	  follows	  through	  with	  the	  
treatment.	  What	  is	  happening	  around	  the	  world	  is	  
that	  MDR-­‐TB	  is	  spreading,	  China	  being	  the	  second	  
highest	  country,	  behind	  India,	  and	  the	  United	  States	  
further	  down	  on	  the	  list	  (Luo	  et	  al.).	  What	  is	  the	  
difference	  between	  these	  two	  countries	  and	  how	  do	  
their	  problems	  to	  solve	  this	  epidemic	  differ?	  
	  
	  
In	  the	  United	  States:	  
In	  the	  United	  States	  in	  2011	  there	  has	  been	  a	  decrease	  in	  the	  
number	  of	  reported	  TB	  cases.	  It	  has	  come	  to	  about	  3.4	  cases	  per	  
100,000	  people.	  Since	  2010	  there	  has	  been	  a	  5.8%	  to	  6.4%	  
decrease	  in	  number	  of	  reported	  cases	  ("Fact	  Sheet	  Trends	  in	  
Tuberculosis	  2011").	  This	  is	  the	  lowest	  recording	  of	  cases	  since	  
naBonal	  reporBng	  began	  in	  1953	  (“Fact	  Sheet…”).	  Despite	  being	  
the	  3rd	  most	  populated	  country	  (behind	  India	  in	  2nd	  and	  China	  
1st),	  esBmated	  at	  313.8	  million	  people,	  there	  is	  a	  relaBvely	  low	  
level	  of	  TB	  (“The	  World	  Fact	  Book”).	  Despite	  this	  good	  news	  in	  
the	  decrease	  of	  TB	  as	  a	  whole	  there	  was	  a	  slight	  increase	  in	  
MDR-­‐TB	  from	  2010	  to	  2011.	  When	  looking	  at	  drug	  suscepBbility	  
in	  cases	  with	  no	  prior	  treatment,	  the	  results	  increased	  from	  
1.2%	  to	  1.3%	  in	  2011	  (“Fact	  sheet…”).	  	  
This	  is	  a	  small	  change	  but	  in	  the	  big	  picture	  a	  significant	  one.	  All	  
of	  the	  cases	  tested	  had	  never	  before	  received	  treatment	  so	  this	  
was	  not	  just	  about	  people	  improperly	  taking	  their	  medicaBon	  or	  
not	  doing	  so	  in	  a	  Bmely	  fashion.	  This	  was	  the	  already	  changed	  
TB	  bacterium	  in	  a	  new	  person.	  These	  numbers	  have	  remained	  
relaBvely	  the	  same	  but,	  in	  foreign-­‐born	  people	  the	  number	  of	  
MDR-­‐TB	  cases	  has	  increased	  from	  25.3%	  in	  1993,	  to	  82.7%	  in	  
2011	  (“Fact	  Sheet…”).	  This	  is	  a	  huge	  and	  steady	  increase	  of	  
30.6%	  in	  18	  years	  .	  If	  trends	  were	  to	  conBnue	  steadily	  with	  no	  
change,	  in	  another	  18	  years	  there	  would	  be	  90.4%	  of	  foreign-­‐
born	  cases	  of	  MDR-­‐TB	  in	  the	  United	  States	  (	  See	  Graph	  1).	  It	  
seems	  that	  in	  the	  U.S.	  the	  most	  common	  way	  of	  gehng	  MDR-­‐TB	  
is	  to	  come	  into	  contact	  with	  someone	  that	  already	  has	  it,	  and	  if	  
the	  number	  of	  people	  who	  have	  it	  conBnues	  to	  increase	  there	  
will	  be	  issues	  for	  many	  –	  “regular”	  TB	  might	  go	  away	  and	  the	  
new	  MDR-­‐TB	  could	  become	  the	  norm.	  Other	  drugs	  are	  already	  
created	  for	  3rd	  and	  4th	  line	  anBbioBc	  treatments	  but	  RIF	  and	  INH	  
are	  the	  most	  potent	  of	  all	  of	  these	  drugs.	  Right	  now	  there	  is	  
even	  an	  extremely	  drug	  resistant	  strain	  of	  TB	  (XDR-­‐TB)	  that	  is	  
resistant	  to	  any	  fluoroquinolone	  and	  an	  injectable	  2nd	  line	  drug	  
and	  is	  being	  deemed	  by	  scienBsts	  as	  one	  of	  the	  biggest	  health	  
threats	  in	  the	  21st	  century	  (Luo	  et	  al.).	  This	  is	  just	  looking	  at	  the	  
United	  States,	  in	  China	  things	  are	  much	  worse.	  
	  
In	  China:	  
China	  is	  ranked	  as	  the	  2nd	  highest	  
country	  of	  reported	  TB	  cases.	  Despite	  
having	  generous	  funding	  from	  their	  
government	  and	  from	  naBonal	  
organizaBons	  there	  is	  sBll	  a	  large	  
problem	  (“China”).	  In	  2011	  with	  a	  
populaBon	  of	  1,348	  million	  people	  
there	  are	  about	  104	  cases	  of	  TB	  per	  
100,000	  people.	  The	  total	  of	  new	  and	  
relapse	  cases	  of	  TB	  in	  2011	  was	  
899,699	  (“China”).	  The	  number	  of	  
overall	  prevalence	  of	  TB	  in	  China	  has	  
decreased	  from	  1990-­‐2006	  but	  out	  of	  
the	  almost	  900,000	  people	  with	  TB	  
only	  13,349	  were	  tested	  for	  MDR-­‐TB.	  
Out	  of	  the	  confirmed	  1,601	  paBents	  
confirmed	  to	  have	  MDR-­‐TB	  only	  1,155	  
were	  started	  on	  a	  treatment	  (“China”).	  
That	  means	  there	  were	  446	  people	  in	  
China	  that	  new	  they	  had	  a	  drug	  
resistant	  form	  of	  TB	  and	  either	  could	  
not	  get	  treatment	  or	  chose	  not	  to.	  Out	  
of	  millions	  of	  people	  this	  number	  may	  
seem	  insignificant	  and	  according	  to	  the	  
Mayo	  Clinic,	  
“Although	  tuberculosis	  is	  contagious,	  
it's	  not	  easy	  to	  catch.	  You're	  much	  
more	  likely	  to	  get	  tuberculosis	  from	  
someone	  you	  live	  with	  or	  work	  with	  
than	  from	  a	  stranger.”	  (Mayo	  Clinic	  
Staff)	  
Although	  it	  may	  not	  be	  the	  easiest	  to	  
catch	  that	  is	  sBll	  446	  people	  with	  
families,	  friends,	  jobs,	  that	  most	  likely	  
can’t	  just	  stop	  their	  life	  for	  having	  this	  
disease.	  Even	  those	  that	  are	  gehng	  
this	  disease	  there	  were	  sBll	  26%	  of	  
MDR-­‐TB	  paBents	  had	  to	  be	  re-­‐treated.	  
So	  somewhere	  in	  their	  life	  they	  
personally	  were	  not	  taking	  their	  
medicaBon	  properly,	  couldn’t	  get	  
access	  to	  them	  or	  came	  into	  contact	  
with	  someone	  who	  also	  had	  MDR-­‐TB	  
(“China”).	  	  
	  
Findings:	  
When	  looking	  at	  both	  of	  these	  countries	  and	  their	  
problems	  with	  TB	  and	  MDR-­‐TB	  there	  are	  different	  
issues	  each	  needs	  to	  handle.	  In	  the	  United	  States,	  
controlling	  travel	  to	  and	  from	  foreign	  countries	  as	  well	  
as	  incoming	  immigrants	  is	  a	  serious	  challenge	  but	  the	  
biggest	  one	  when	  dealing	  with	  the	  TB	  problem.	  They	  
are	  having	  trouble	  controlling	  its	  movement	  into	  the	  
country.	  Whereas	  in	  China	  they	  hare	  having	  trouble	  
controlling	  the	  epidemic	  that	  is	  already	  there	  –	  and	  
spreading.	  The	  impoverished	  areas	  of	  China	  are	  more	  
suscepBble	  to	  disease	  but	  that	  does	  not	  mean	  the	  
cramped	  major	  ciBes	  of	  China	  such	  as	  Beijing,	  which	  
has	  it’s	  own	  strain	  of	  TB,	  is	  not	  going	  to	  be	  affected	  
(Burman	  et	  al.).	  The	  Beijing	  strain	  which	  has	  been	  to	  
more	  places	  than	  just	  around	  China’s	  provinces	  has	  
been	  known	  to	  be	  drug	  resistant	  and	  is	  being	  put	  
through	  further	  scruBny	  to	  help	  idenBfy	  cases	  affected	  
by	  this	  strain	  and	  be	  able	  to	  beIer	  treat	  them	  
(Burman	  et.	  al.).	  	  
Conclusion:	  
In	  conclusion,	  many	  countries	  have	  terrible	  
problems	  with	  TB	  and	  MDR-­‐TB.	  Whether	  
those	  countries	  happen	  to	  be	  towards	  the	  
top	  like	  China,	  or	  towards	  the	  boIom	  of	  the	  
list	  in	  severity	  of	  prevalence	  like	  the	  United	  
States	  these	  diseases	  are	  sBll	  killing	  millions	  
every	  year.	  Plans	  and	  strategies	  are	  being	  
created	  and	  uBlized	  by	  the	  World	  Health	  
OrganizaBon	  (WHO)	  and	  individual	  
governments	  but	  despite	  many	  efforts	  this	  
bacterium	  is	  growing	  stronger	  and	  becoming	  
more	  resilient.	  	  
0	  
10	  
20	  
30	  
40	  
50	  
60	  
70	  
80	  
90	  
100	  
1993	   2011	   2029	  
%
	  o
f	  f
or
ei
gn
	  b
or
n	  
M
DR
-­‐T
B	  
in
	  th
e	  
U
.S
.	  
Years	  
Foreign	  Born	  MDR-­‐TB	  in	  the	  U.S.	  Projec=on	  
Progression	  of	  
MDR-­‐TB	  
Graph	  1	  	  
Image	  1	  (Gareths,	  et.al)	  
WHO	  Global	  Health	  Report	  2013	  
According	  to	  the	  Center	  for	  Disease	  
Control	  and	  preven=on	  (CDC)	  there	  
are	  a	  few	  reasons	  that	  MDR-­‐TB	  
would	  develop.	  	  
“When	  people	  do	  not	  complete	  the	  
full	  course	  of	  treatment,	  when	  
health	  care	  providers	  prescribe	  the	  
wrong	  treatment,	  the	  wrong	  dose,	  
or	  wrong	  length	  of	  =me	  for	  taking	  
the	  drugs,	  when	  the	  supply	  of	  
drugs	  is	  not	  always	  available,	  or	  
when	  the	  drugs	  are	  of	  poor	  
quality.”	  (“Drug	  Resistant	  TB”)	  
	  
Contact:	  healymk2@vcu.edu	   Please	  see	  aIached	  paper	  for	  bibliography	  
Mycobacterium	  tuberculosis	  colored	  scanning	  electron	  micrograph	  (SEM)	  under	  15549x	  magnificaBon.	  M.	  tuberculosis	  is	  an	  
obligate	  anaerobic	  bacterium,	  meaning	  it	  can	  only	  survive/grow	  in	  oxygenated	  environments	  (Public	  Health	  Image	  Library).	  
	  


English

A Look at Tuberculosis and Multi-Drug Resistant TB in the United States & China

Virginia Commonwealth UniversityVCU Scholars CompassUndergraduate Research Posters Undergraduate Research Opportunities Program2014A Look at Tuberculosis and Multi-Drug ResistantTB in the United States & ChinaMegan K. HealyVirginia Commonwealth UniversityFollow this and additional works at: http://scholarscompass.vcu.edu/uresposters© The Author(s)This Article is brought to you for free and open access by the Undergraduate Research Opportunities Program at VCU Scholars Compass. It has beenaccepted for inclusion in Undergraduate Research Posters by an authorized administrator of VCU Scholars Compass. For more information, pleasecontact libcompass@vcu.edu.Downloaded fromHealy, Megan K., "A Look at Tuberculosis and Multi-Drug Resistant TB in the United States & China" (2014). Undergraduate ResearchPosters. Poster 68.http://scholarscompass.vcu.edu/uresposters/68A Look at Tuberculosis and Multi-Drug Resistant TB !in the United States & China!Megan K. Healy!Anthropology Major, School of World Studies!Abstract:	  There	  are	  many	  things	  plaguing	  the	  world	  today,	  one	  of	  them	  is	  Mycobacterium	  tuberculosis	  otherwise	  known	  as	  Tuberculosis	  (TB).	  Since	  it’s	  origin	  TB	  has	  become	  more	  virulent	  against	  anBbioBcs	  and	  became	  mulB-­‐drug	  resistant	  (MDR-­‐TB).	  Two	  countries	  come	  to	  mind	  for	  comparison,	  China	  and	  the	  United	  States.	  China	  is	  having	  severe	  problems	  with	  the	  disease	  while	  the	  United	  States	  is	  managing	  it	  a	  bit	  beIer.	  Each	  country	  has	  unique	  circumstances	  and	  the	  staBsBcs	  show	  that	  both	  may	  be	  doing	  beIer	  with	  just	  TB	  but	  MDR-­‐TB	  is	  sBcking	  around	  and	  gradually	  becoming	  more	  and	  more	  of	  an	  issue.	  	  	  	  IntroducBon:	  Every	  year	  there	  are	  millions	  of	  diagnosis’	  and	  deaths	  due	  to	  the	  disease,	  Tuberculosis	  (TB)	  ("Tuberculosis	  Data	  and	  StaBsBcs.").	  Tuberculosis	  caused	  by	  the	  bacteria,	  Mycobacterium	  tuberculosis,	  is	  a	  pulmonary	  infecBon	  that	  can	  get	  into	  a	  person’s	  lungs	  via	  the	  air,	  blood,	  or	  lymph.	  The	  bacterium	  insBgates	  the	  lung	  to	  form	  “ﬁbrous	  nodules	  called	  tubercles”	  around	  the	  bacteria	  itself	  (Saladin	  888).	  The	  main	  symptoms	  of	  TB	  include,	  coughing	  up	  blood	  or	  sputum,	  chest	  pain,	  and	  coughing	  that	  gets	  worse	  over	  three	  weeks	  (“Basic	  TB	  Facts”).	  The	  control	  of	  this	  disease	  is	  made	  more	  diﬃcult	  because	  two	  of	  the	  three	  main	  symptoms	  are	  also	  modes	  of	  transmission	  (See	  Image	  1).	  As	  of	  right	  now	  there	  is	  a	  way	  to	  kill	  the	  bacteria	  in	  those	  who	  are	  sick	  with	  many	  diﬀerent	  lines	  of	  anBbioBcs.	  What	  is	  happening,	  and	  has	  been	  developing	  is	  that	  the	  TB	  bacterium	  is	  becoming	  resistant	  to	  anBbioBcs.	  What	  this	  means	  is,	  that	  TB	  has	  become	  mulB-­‐drug	  resistant	  (MDR)	  the	  ﬁrst	  and	  second	  lines	  of	  anBbioBcs	  used	  to	  treat	  TB,	  rifampin	  (RIF)	  and	  isoniazid	  (INH)	  are	  ineﬀecBve	  to	  treat	  the	  disease	  (Luo	  et	  al.).	  In	  most	  cases	  of	  TB	  these	  two	  drugs	  work	  as	  long	  as	  the	  paBent	  follows	  through	  with	  the	  treatment.	  What	  is	  happening	  around	  the	  world	  is	  that	  MDR-­‐TB	  is	  spreading,	  China	  being	  the	  second	  highest	  country,	  behind	  India,	  and	  the	  United	  States	  further	  down	  on	  the	  list	  (Luo	  et	  al.).	  What	  is	  the	  diﬀerence	  between	  these	  two	  countries	  and	  how	  do	  their	  problems	  to	  solve	  this	  epidemic	  diﬀer?	  	  	  In	  the	  United	  States:	  In	  the	  United	  States	  in	  2011	  there	  has	  been	  a	  decrease	  in	  the	  number	  of	  reported	  TB	  cases.	  It	  has	  come	  to	  about	  3.4	  cases	  per	  100,000	  people.	  Since	  2010	  there	  has	  been	  a	  5.8%	  to	  6.4%	  decrease	  in	  number	  of	  reported	  cases	  ("Fact	  Sheet	  Trends	  in	  Tuberculosis	  2011").	  This	  is	  the	  lowest	  recording	  of	  cases	  since	  naBonal	  reporBng	  began	  in	  1953	  (“Fact	  Sheet…”).	  Despite	  being	  the	  3rd	  most	  populated	  country	  (behind	  India	  in	  2nd	  and	  China	  1st),	  esBmated	  at	  313.8	  million	  people,	  there	  is	  a	  relaBvely	  low	  level	  of	  TB	  (“The	  World	  Fact	  Book”).	  Despite	  this	  good	  news	  in	  the	  decrease	  of	  TB	  as	  a	  whole	  there	  was	  a	  slight	  increase	  in	  MDR-­‐TB	  from	  2010	  to	  2011.	  When	  looking	  at	  drug	  suscepBbility	  in	  cases	  with	  no	  prior	  treatment,	  the	  results	  increased	  from	  1.2%	  to	  1.3%	  in	  2011	  (“Fact	  sheet…”).	  	  This	  is	  a	  small	  change	  but	  in	  the	  big	  picture	  a	  signiﬁcant	  one.	  All	  of	  the	  cases	  tested	  had	  never	  before	  received	  treatment	  so	  this	  was	  not	  just	  about	  people	  improperly	  taking	  their	  medicaBon	  or	  not	  doing	  so	  in	  a	  Bmely	  fashion.	  This	  was	  the	  already	  changed	  TB	  bacterium	  in	  a	  new	  person.	  These	  numbers	  have	  remained	  relaBvely	  the	  same	  but,	  in	  foreign-­‐born	  people	  the	  number	  of	  MDR-­‐TB	  cases	  has	  increased	  from	  25.3%	  in	  1993,	  to	  82.7%	  in	  2011	  (“Fact	  Sheet…”).	  This	  is	  a	  huge	  and	  steady	  increase	  of	  30.6%	  in	  18	  years	  .	  If	  trends	  were	  to	  conBnue	  steadily	  with	  no	  change,	  in	  another	  18	  years	  there	  would	  be	  90.4%	  of	  foreign-­‐born	  cases	  of	  MDR-­‐TB	  in	  the	  United	  States	  (	  See	  Graph	  1).	  It	  seems	  that	  in	  the	  U.S.	  the	  most	  common	  way	  of	  gehng	  MDR-­‐TB	  is	  to	  come	  into	  contact	  with	  someone	  that	  already	  has	  it,	  and	  if	  the	  number	  of	  people	  who	  have	  it	  conBnues	  to	  increase	  there	  will	  be	  issues	  for	  many	  –	  “regular”	  TB	  might	  go	  away	  and	  the	  new	  MDR-­‐TB	  could	  become	  the	  norm.	  Other	  drugs	  are	  already	  created	  for	  3rd	  and	  4th	  line	  anBbioBc	  treatments	  but	  RIF	  and	  INH	  are	  the	  most	  potent	  of	  all	  of	  these	  drugs.	  Right	  now	  there	  is	  even	  an	  extremely	  drug	  resistant	  strain	  of	  TB	  (XDR-­‐TB)	  that	  is	  resistant	  to	  any	  ﬂuoroquinolone	  and	  an	  injectable	  2nd	  line	  drug	  and	  is	  being	  deemed	  by	  scienBsts	  as	  one	  of	  the	  biggest	  health	  threats	  in	  the	  21st	  century	  (Luo	  et	  al.).	  This	  is	  just	  looking	  at	  the	  United	  States,	  in	  China	  things	  are	  much	  worse.	  	  In	  China:	  China	  is	  ranked	  as	  the	  2nd	  highest	  country	  of	  reported	  TB	  cases.	  Despite	  having	  generous	  funding	  from	  their	  government	  and	  from	  naBonal	  organizaBons	  there	  is	  sBll	  a	  large	  problem	  (“China”).	  In	  2011	  with	  a	  populaBon	  of	  1,348	  million	  people	  there	  are	  about	  104	  cases	  of	  TB	  per	  100,000	  people.	  The	  total	  of	  new	  and	  relapse	  cases	  of	  TB	  in	  2011	  was	  899,699	  (“China”).	  The	  number	  of	  overall	  prevalence	  of	  TB	  in	  China	  has	  decreased	  from	  1990-­‐2006	  but	  out	  of	  the	  almost	  900,000	  people	  with	  TB	  only	  13,349	  were	  tested	  for	  MDR-­‐TB.	  Out	  of	  the	  conﬁrmed	  1,601	  paBents	  conﬁrmed	  to	  have	  MDR-­‐TB	  only	  1,155	  were	  started	  on	  a	  treatment	  (“China”).	  That	  means	  there	  were	  446	  people	  in	  China	  that	  new	  they	  had	  a	  drug	  resistant	  form	  of	  TB	  and	  either	  could	  not	  get	  treatment	  or	  chose	  not	  to.	  Out	  of	  millions	  of	  people	  this	  number	  may	  seem	  insigniﬁcant	  and	  according	  to	  the	  Mayo	  Clinic,	  “Although	  tuberculosis	  is	  contagious,	  it's	  not	  easy	  to	  catch.	  You're	  much	  more	  likely	  to	  get	  tuberculosis	  from	  someone	  you	  live	  with	  or	  work	  with	  than	  from	  a	  stranger.”	  (Mayo	  Clinic	  Staﬀ)	  Although	  it	  may	  not	  be	  the	  easiest	  to	  catch	  that	  is	  sBll	  446	  people	  with	  families,	  friends,	  jobs,	  that	  most	  likely	  can’t	  just	  stop	  their	  life	  for	  having	  this	  disease.	  Even	  those	  that	  are	  gehng	  this	  disease	  there	  were	  sBll	  26%	  of	  MDR-­‐TB	  paBents	  had	  to	  be	  re-­‐treated.	  So	  somewhere	  in	  their	  life	  they	  personally	  were	  not	  taking	  their	  medicaBon	  properly,	  couldn’t	  get	  access	  to	  them	  or	  came	  into	  contact	  with	  someone	  who	  also	  had	  MDR-­‐TB	  (“China”).	  	  	  Findings:	  When	  looking	  at	  both	  of	  these	  countries	  and	  their	  problems	  with	  TB	  and	  MDR-­‐TB	  there	  are	  diﬀerent	  issues	  each	  needs	  to	  handle.	  In	  the	  United	  States,	  controlling	  travel	  to	  and	  from	  foreign	  countries	  as	  well	  as	  incoming	  immigrants	  is	  a	  serious	  challenge	  but	  the	  biggest	  one	  when	  dealing	  with	  the	  TB	  problem.	  They	  are	  having	  trouble	  controlling	  its	  movement	  into	  the	  country.	  Whereas	  in	  China	  they	  hare	  having	  trouble	  controlling	  the	  epidemic	  that	  is	  already	  there	  –	  and	  spreading.	  The	  impoverished	  areas	  of	  China	  are	  more	  suscepBble	  to	  disease	  but	  that	  does	  not	  mean	  the	  cramped	  major	  ciBes	  of	  China	  such	  as	  Beijing,	  which	  has	  it’s	  own	  strain	  of	  TB,	  is	  not	  going	  to	  be	  aﬀected	  (Burman	  et	  al.).	  The	  Beijing	  strain	  which	  has	  been	  to	  more	  places	  than	  just	  around	  China’s	  provinces	  has	  been	  known	  to	  be	  drug	  resistant	  and	  is	  being	  put	  through	  further	  scruBny	  to	  help	  idenBfy	  cases	  aﬀected	  by	  this	  strain	  and	  be	  able	  to	  beIer	  treat	  them	  (Burman	  et.	  al.).	  	  Conclusion:	  In	  conclusion,	  many	  countries	  have	  terrible	  problems	  with	  TB	  and	  MDR-­‐TB.	  Whether	  those	  countries	  happen	  to	  be	  towards	  the	  top	  like	  China,	  or	  towards	  the	  boIom	  of	  the	  list	  in	  severity	  of	  prevalence	  like	  the	  United	  States	  these	  diseases	  are	  sBll	  killing	  millions	  every	  year.	  Plans	  and	  strategies	  are	  being	  created	  and	  uBlized	  by	  the	  World	  Health	  OrganizaBon	  (WHO)	  and	  individual	  governments	  but	  despite	  many	  eﬀorts	  this	  bacterium	  is	  growing	  stronger	  and	  becoming	  more	  resilient.	  	  0	  10	  20	  30	  40	  50	  60	  70	  80	  90	  100	  1993	   2011	   2029	  %	  of	  foreign	  born	  MDR-­‐TB	  in	  the	  U.S.	  Years	  Foreign	  Born	  MDR-­‐TB	  in	  the	  U.S.	  Projec=on	  Progression	  of	  MDR-­‐TB	  Graph	  1	  	  Image	  1	  (Gareths,	  et.al)	  WHO	  Global	  Health	  Report	  2013	  According	  to	  the	  Center	  for	  Disease	  Control	  and	  preven=on	  (CDC)	  there	  are	  a	  few	  reasons	  that	  MDR-­‐TB	  would	  develop.	  	  “When	  people	  do	  not	  complete	  the	  full	  course	  of	  treatment,	  when	  health	  care	  providers	  prescribe	  the	  wrong	  treatment,	  the	  wrong	  dose,	  or	  wrong	  length	  of	  =me	  for	  taking	  the	  drugs,	  when	  the	  supply	  of	  drugs	  is	  not	  always	  available,	  or	  when	  the	  drugs	  are	  of	  poor	  quality.”	  (“Drug	  Resistant	  TB”)	  	  Contact:	  healymk2@vcu.edu	   Please	  see	  aIached	  paper	  for	  bibliography	  Mycobacterium	  tuberculosis	  colored	  scanning	  electron	  micrograph	  (SEM)	  under	  15549x	  magniﬁcaBon.	  M.	  tuberculosis	  is	  an	  obligate	  anaerobic	  bacterium,	  meaning	  it	  can	  only	  survive/grow	  in	  oxygenated	  environments	  (Public	  Health	  Image	  Library).	  	  

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A Look at Tuberculosis and Multi-Drug Resistant TB in the United States & China

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