United States (US)-Mexican Border: TB Resistance and Challenges, continued

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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: TB Resistance and Challenges, continued

An example of TB resistance costs at the US-Mexican border:
In related (2010-2012) CDC data documenting antibiotic susceptibility testing for M. tuberculosis:
  • 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 in 2011. Mexico presents an immediate problem for the U.S. as drug violence across the border deters public health officials from acting on the patient's behalf to reduce disease transmission.
  • Patients who were previously treated for TB may not have undergone any susceptibility testing, and are highly likely to be carrying MDR- or XDR-TB strains.
The CDC's loss of funding to control the epidemic of MDR-TB from 2010 to 2012 totaled $4.7 million. Although some were 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 fingerprinting techniques to identify strains, such as IS6110-based restriction fragment length polymorphism (RFLP), researchers estimated that 1.4% of all California cases (2,324) were drug-resistant in 2010. Although the caseload for San Diego County decreased prior to 2010, an 18.5 % increase was reported from 2010 to 2011. Data suggests that Puentes de Esperanza (Bridges of Hope), a clinic located between San Diego and Baja California (Mexico) providing medical services, including laboratory diagnosis and susceptibility testing to the area, has been threatened with closure because of insufficient funding. (UPDATE: Since this initial study report, public health partnerships have helped fund the clinic from year to year in an effort to continue important TB treatments.)
In 2020 dollars -- The cost for direct drug treatment:
One case of drug-susceptible TB costs approximately $20,000, one case of MDR-TB requires $182,000, and a case of XDR-TB requires $568,000. The cost of drugs, as well as the extended time (months to years) of treatment, are included in these CDC estimates (but the loss of productivity is not included).