San Diego County Joins Binational Effort To Prevent, Control Tuberculosis

San Diego County health officials say collaboration they've had with Imperial County and Baja California for years was made official last week. Agencies have signed an agreement to work together and control the spread of tuberculosis. The number of TB patients has declined dramatically in San Diego over the past 20 years but the problem of fighting the disease the border region remains challenging. TB rates are a continuing problem in Imperial County which has the highest number of cases and all of California's counties. And Baja which has the highest rate of TB in Mexico pick a Joining me to join how the collaboration works are my guests Dr. Kathleen Mosier director of San Diego County health and human services agencies TB and refugee health branch and Dr. Mosher welcome to the show but the Alana Ortez is also here. She's program manager with the international committee foundation. Dr. Mosher, I think for Americans tuberculosis seems like a disease from another era. What is it and how to get it. I get that a lot. Tuberculosis is a bacterial action and the reason it's a public health concern is that it's airborne. It's a generally in the lungs and transmitted from person to person. The other thing is that it takes a long time to cure tuberculosis. Six months to two years. Design we still have it with us at today with leading causes of death in many countries outside the US. It is a fatal disease if it goes untreated. It can be fatal. It's very terrible within the US. If you have a delay in diagnosis is not treated properly. Did kids in the US received immunizations for TV? No. At this point in the US we don't use of vaccination for tuberculosis but in almost every country there is a vaccine called BCG. Many of the listeners have received that if they are born outside the US The problem with BCG is although a protects children from getting bad forms of tuberculosis, it doesn't seem to prevent tuberculosis in adults. Why are kids in the US vaccinated? There's two reasons. One it's not a very effective vaccine. One of the areas of research is looking for the vaccine which will really work for children and adults. The other reason is we went a different way in the 60s. Decided not to vaccinate and what we do is test you for TB and if positive we give you medication. How is it treated? It's treated with a variety of antibiotics. You'd starts on or antibiotics at the same time. Then you continue on those for six months and in some cases if you resistant forms were of two years for the You take daily treatment for all that time. There are drug-resistant strains of TB? Yes. This is a very slow moving organism. Internets, is a very good at avoiding the drugs we use if we don't use of them a perfect race. Around the world, those half 1 million very drug-resistant people -- forms of the disease. The way we avoid that in the US, when you take your medications, we are going to watch you and help you take your medicine every day. In that way are rates of drug resistance are quite low. Alana Ortez, here in San Diego we have a higher rate of tuberculosis. It's a sad because of our cosponsor the need to the border. What's the connection to the border and our rate of TB. Our involvement with TB in this work is knowing that border regions tend to have higher rates of many infectious diseases because there's higher risk populations, operations are transient and moving place to place so& Can come from other parts of Mexico. That movement and fluidity of the border area as part of the problem and also as we know there's economic disparities in our border region. He went of having people who have higher risk behaviors and therefore are more exposed and more at risk of contagion and passing an illness. We find a lot where there are people engaging in higher risk behaviors, their people that because of their socioeconomic situation don't have stable housing. All those high risk activities can lead to higher risks and almost as well prove I read that TV is often thought of as a disease of poverty. Does that encompass the high risk of behavior they were talking met? I think poverty is one of the risk factors, you may not have access to to care as reality so your disease may spread. It's not only a disease of poverty. We see the highest rates among the elderly. It simply because they were young when TB was so prevalent in the US and you can hold TB in your body your entire life strangely and then it comes out when you're elderly. That's one of the risk factors. Would've the other populations of vulnerable to contracting TB? Immigrant populations. People who have any condition which lowers their immune system. Alerts HIV or something like diabetes or renal failure, they are at rest. -- At risk. People in correctional facilities or abuse of drugs. There's an entire group of different segments of the population that are at risk. How big a problem is tuberculosis in Baja? I don't have the numbers in front of me, we do know Baja California has the highest rate of tuberculosis at this time. You been working on this for quite some time? We have been able to engage as a convenient and collaborator bringing together the many parties. There's a newly signed agreements. This is an agreement that brings together the counties of San Diego and Imperial. The state of Baja California our foundation and a newly formed nonprofit organization. It has really served as bringing all those parties to the table and allowing them to work together find ways to Connecticut and collaborate in controlling this serious illness. How do you see this collaboration as working it to control and prevent TB? What can the various agencies give to each other that they can't do alone? Dr. Moser. Imagine this will be easier to understand. We have the patient that they are treating and their diagnosing. It's a airborne infectious disease. That individual has people they see on the US side in San Diego perhaps because They need to talk to us because we have to explore to an investigation around those people they may have exposed to see if they have TB. On the Baja site right now, they don't have the laboratory infrastructure as we do on the US side so they may not know all the details about that person's illness that we need to know to do it good investigation. We have the laboratory and for sure sure. One of the things this collaboration, how to eat sure that lap and for sure sure? Do they bring specimens over here? To increase their capacity. It's one of the tangible things some of this money and resources can go to. Would also serve to help agencies track and monitor people who were perhaps lapsing in it the way they actually took the treatment for their TB? Yes. Was really unique about the work they have done in helping to foster and formalize that on profit -- nonprofit. It helps to bolster the work of the government agencies and continue the outreach in the communities where the counties in the state of Baja may not be able to get out to where the people are because This works with community health workers and they go out to the people that need treatment and ensure they are getting their daily treatment sometimes twice a day. Dr. Moser, I want to talk about analyzing the type of tuberculosis that someone may have contracted. Does the accurate typing of that determine what kind of tomb is going to be used? Yes. The World Health Organization guidance for many resource limited countries is the first time through treatment, you use them -- empiric therapy because of the resource limitations. What does that mean? You choose these particular medications without necessarily testing in the laboratory. It should work, other studies that show it should work. The second time through, they didn't respond to that and maybe you go to culturing techniques to learn the specific one. That's the way it's done all over the world. Is turning out that more more World Health Organization countries are saying maybe we want to go to culturing earlier on because it isn't working exactly as for many patients. When you're in a border region or to the culturing for all of our patients and they don't. That's where we say we can do this in the border region we just need to bring resources and willingness on both sides. We could treat every patient upfront exactly as they should be treated. Dr. Mosher, you mentioned a little while ago this idea of observed therapy. Making sure patients take their medications. A lot of us telling us about how this new nonprofit is going to be able to augment providers who go out to hard-to-reach regions to see if TB patients are taking the medicine. How does that work here? Is it technology changing how we can observe whether or not partaking their required medication? Just a few years ago we had individuals drive out to everyone's home was on TB treatment and watch you take your medicine. Now we have started to get with it, basically. Now we have technology here are people can videotape themselves taking the medicine and we can watch it the same day. We have adjustable sensors -- in just a bowl sensors. That has really helped us serve some of our patients were ready for that technology. We would love to be able to bring that sort of technology and strategy in Baja California and patients who cross the border live on one side of work on the other. A lot of people might listen to this and say someone has a fatal disease it's communicable. Why do they have to be monitored in this way to take their medications? Are the medications themselves a problem? I'm going to say it's human nature. If we just think about how many times we have been prescribed 10 days of antibiotic, and we haven't quite finished it all because we are feeling better by four or five days. Multiply that by four different antibiotics for six months or longer and you feel better even the sickest person with TB in the beginning, they felt pretty good by one month. It's very difficult for people to believe they really need to take medicine. They relapse to the The bigger problem in some ways is you prescribe for different antibiotics maybe after a few weeks so that only fills the need to take one of them That is how Chirag resistance develops. With inappropriate taking of medication Having worked with this for such a long time, Alana, what would you say was the biggest challenge or challenges to stopping the private -- spread it to be? We are working with professionals who know what they're doing. I don't forget the technical concern. I think for us working in a border region, some of the challenges our political, sometimes bureaucratic. It's really about bring all the important players to the table and getting them to work together. A major concern is funding and have found as a foundation as he talked about earlier, one of the challenges is this is such a slow long-term illness. It takes a lot of resources and time to treat each individual case. It's difficult for people who want to support an issue to see their dollars right away. It's hard to sell it to a donor. That's where it has been critical in the technology. We are working on how to bring mobile technology into health treatment looking at interested in finding innovative ways to address these illnesses. I think philanthropic dollars can play a role in how you export new technologies to treat tuberculosis. Would you agree with what I want says? I think there's so many reasons TB is hard to control. Another area is education. I think because TV presents many others like on Congress -- like bronchitis. It takes a long time to get diagnosed. Another area is educating the high-risk populations whether there in the great populations. And then for providers in some ways on the Mexican side of the border people get diagnosed more quickly because TV is more common sometimes a diagnosed later attracting donors has been also a challenge. Just because the numbers are 220 cases of in San Diego County. Their 1700 and Baja California it's a larger. Compared to other diseases it seems so small to donors for the I'm glad you're able to come in and talk to us about this. One Ortez -- Thank you both very much.