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Fugitive Patient Raises Cautions and Opportunities

In contrast to pandemic influenza, tuberculosis is a subject that doesn't tend to come up in the news very often. TB did generate some local coverage recently regarding the case of a Madison man who refused treatment and testing for a form of the disease called multi-drug resistant tuberculosis (MDR-TB). Despite orders from his physician, from the Department of Public Health for Madison and Dane County and a Dane County judge requiring treatment testing and monitoring, the man departed the area in January without notice and without leaving a forwarding address.

Following the issuance of a national arrest warrant, he was located last week in Sacramento, California where he remains under close surveillance by local authorities who are ensuring the resumption of his treatment testing and monitoring.

This rare unraveling of essential medical care for an often lethal, contagious disease, MDR-TB, presents an opportunity to shed some much-needed light on a very serious but often ignored subject. Tuberculosis has gradually slipped out of American public consciousness as such factors as better housing, nutrition and medical care, especially antibiotics, have greatly reduced national rates.

However, outside the United States, tuberculosis remains the world's most prevalent infectious disease killer, claiming more than 2 million people annually. It is estimated that one-third of all human beings are infected. Although influenza generated many more headlines in recent years, TB kills more people, year in and year out, than the flu. The recent emergence of the "multi-drug-resistant" strains of TB bacteria has moved the World Health Organization to declare tuberculosis a global emergency. In some parts of the world, approximately one in five of those infected harbor MDR-TB. While the

United States is relatively better off, the ever-escalating scale of international travel demands that local public health representatives provide constant vigilance and forceful response.

During 2006, Madison and Dane County Public Health managed 9 cases of tuberculosis, two of which were MDR-TB. Each case of TB requires complicated and lengthy medical care that for MDR-TB averages two years of almost daily, supervised medication given orally and by injection. The cost is hundreds of thousands of dollars per case. Individuals, and there are often many, infected by each case also require lengthy treatment

Management of the recent, highly publicized case of MDR-TB required a very high level of cooperation and coordination among local public health, physicians and hospital-based services, the police and judicial authorities. According to Dr. Thomas Schlenker, director of Public Health for Madison and Dane County, "Tuberculosis challenges, almost daily, the capacity of our local public health system and, in my opinion, is the best training available to prepare for the arrival of pandemic influenza."

"Local tuberculosis control demands excellence in surveillance, contact investigation, non-traditional, community and household-based therapy, isolation and quarantine and social/cultural sensitivity. All key elements of pandemic flu preparedness. Also, the trust and understanding built among the public health nurses, clinical nurses, physicians, State health authorities, police, attorneys, judges and policy makers who work together on TB control will be essential to our survival should the influenza pandemic strike."

For a list of frequently asked questions and answers about TB, please see the fact sheet produced by the Centers for Disease Control at

For this same information in Spanish, use the following link: (para la misma información en español consulte el enlace siguiente):

For information on how Dane County compares to the rest of the state, please see the Wisconsin Tuberculosis Program website at

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  • Jeffrey Golden, 267-2583