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The page below is a sample from the LabCE course Tracking Antibiotic-Resistant Tuberculosis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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United States (US)-Mexican Border, continued

The CDC’s U.S. 2010 data documenting antibiotic susceptibility testing for M. tuberculosis is the most recent available (as of 2013). Reports for isoniazid and rifampin were included for more than 97% of cases confirmed by culture. In individuals with a history of treatment for TB, the percentage of drug resistance was nearly four times that of those never treated. In the U.S., there were 109 cases of multidrug-resistant TB (MDR-TB), and 106 of those cases were foreign-born (from Mexico, Vietnam, India, the Philippines, and others). Four cases of extensively drug-resistant (XDR-TB) were reported in foreign-born individuals for 2011. Mexico presents an immediate problem for the U.S. as drug violence across the border deters public health officials from acting on the patients' behalf to reduce disease transmission.
The CDC's loss of funding to control the epidemic of MDR-TB from 2010 to 2012 totaled $4.7 million. Although some was recovered ($209,000) in 2011-2012, funding for the Public Health Department of California dropped by $1.4 million in the years from 2007 to 2010. Meanwhile, the total number of TB cases in Mexico increased from 1,275 in 2006 to 1,547 in 2010.
Using DNA finger-printing techniques to identify strains, such as IS6110-based restriction fragment length polymorphism (RFLP), researchers estimate that 1.4% of all California cases (2,324) were drug resistant in 2010. Although the case load for San Diego County decreased prior to 2010, an 18.5 % increase was reported from 2010 to 2011. If these data are correct, Puentes de Esperanza (Bridges of Hope), a clinic located between San Diego and Baja California (Mexico) that provides medical services including laboratory diagnosis and susceptibility testing, will be forced to close because of insufficient funding. Compared to the $50 per treatment of susceptible strains, one case of MDR-TB requires $100,000 to $200,000 for a 60% to 90% cure-rate. To treat a case of XDR-TB with a 30% to 50% cure-rate, more than $600,000 is required.