Persistent TB worries health pros

Although state cases down, increase seen in some suburbs

By John Biemer, Tribune staff reporter. Tribune staff reporter Mickey Ciokajlo contributed to this report

April 12, 2004

One of the world's deadliest diseases may be down across Illinois, but in a few pockets of the Chicago suburbs, tuberculosis seems to be creeping back up.

According to recently released state health figures, the number of active TB cases in DuPage County almost doubled last year. Thus far this year, cases in the county are on pace to top those in 2003.

The increase in cases--most often occurring in foreign-born individuals--runs counter to the state's overall count, which declined for the seventh straight year. DuPage's total went from 32 cases in 2002 to 62 last year, according to figures released last week by the Illinois Department of Public Health. Lake and Kane Counties also saw smaller increases last year.

Jane Zimmerman, DuPage County's associate director of community health services, said it is too early to tell if the increase represents a trend or a one-year blip. In both 2000 and 2001, the number of active cases in DuPage was 48.

"Why it jumped up to 62, which is the highest it's been in 10 years, we really don't know," she said. But she noted that it's costing the county more and causing nurses to work longer hours.

About 63 percent of last year's cases were foreign-born individuals, mostly those born in India, the Philippines and Mexico--and health officials say they often do not have insurance. Through April 1 of this year, DuPage already had recorded 23 active cases, although not all of those have been confirmed.

The number of TB cases among foreign-born people remains disproportionately high statewide, making up 271 of the state's 633 reported cases in 2003. Still, overall numbers are consistently dropping statewide. In the last decade, cases in Illinois have fallen 43 percent. In 2002, the state had 680 cases.

Tuberculosis is a contagious and potentially deadly disease marked by coughing and sneezing that is transmitted by tiny airborne particles of bacteria. It can affect any part of the body, including the brain, kidneys and spine, but usually affects the lungs.

TB is usually curable, but someone with the disease must adhere to a prescribed drug therapy for six months or longer. The World Health Organization estimates that 2 million people died of TB in 2002, with the highest number in South and East Asia.

When a member of a Winnetka tennis club recently tested positive for the disease, health workers began testing hundreds of people who may have come in contract with him, officials announced last week. They say it appears that nobody else at the club was infected.

In Chicago and Cook County, overall cases were down in 2003, dipping to 462 from 512 in 2002. Nonetheless, the Suburban Cook County Tuberculosis Sanitarium District had a 29 percent increase in clinic visits with 110,197 in 2003, including 123 active cases and 2,691 latent cases. Seven in 10 cases were foreign-born individuals.

Because the disease remains persistent, a leading DuPage official has expressed alarm at legislation moving forward in Springfield that would disband the Cook County sanitarium district, which has clinics in Forest Park, Des Plaines and Harvey and a nearly 25-acre facility in Hinsdale.

The Civic Federation, a taxpayer watchdog group, and other critics have argued that the district, with an annual $3.5 million property tax levy, has a staff that's overloaded with management and clerical workers, and a per-patient cost for services that's more than twice that of Chicago's Public Health Department, which handles almost three times as many cases.

Dissolving the district would be a demonstration of good faith to taxpayers, the critics say, because the district continues to levy its annual property tax even though it's accumulated $10 million in surplus funds, while Cook County is strapped for cash.

But Irene Stone, a Republican DuPage County Board member from Lombard who sits on the Health and Human Services Committee, fears her county will pay a price if those facilities are closed. She points out that 100,000 commuters come into DuPage from Cook daily--giving the disease ample opportunity to spread.

"What net worth is there in government seeking a monetary gain that would help promote pestilence for their constituents?" Stone asked, calling the district "the last bastion" to protect 2.5 million suburban Cook County residents from "the scourge of this disease."

There's a political element to the land fight. The district's president is Terrance Carr, the mayor of Willow Springs and the son of Al Carr, a former Republican Cook County commissioner. One vocal proponent of abolishing the district is Tony Peraica, the Republican county commissioner who defeated Al Carr in 2002.

Kitty Loewy, a spokeswoman for the Cook County Department of Public Health, said the county's existing public health apparatus--including clinics in Rolling Meadows, Maywood, Bridgeview and Markham--is ready to absorb cases from the suburban sanitarium district if it's dissolved. That applies, she said, whether caseloads remain at about the same level or even if there's a significant spike due to an event as extreme as a bioterrorist attack.

"There's no doubt that this is something that we're prepared to do," she said. "We feel quite comfortable and quite capable of doing this without a problem."

DuPage's Zimmerman said she also has faith that Cook County could take care of all its cases even if the sanitarium closes. But she added that DuPage's recent increase does indicate that now is no time for health officials to declare victory.

What happened in New York in the 1980s should serve as a warning, she said. Faced with declining case rates there, the city dismantled its tuberculosis control infrastructure. The result was a resurgence of the disease: incidences more than doubled from 1984 to 1991, costing the city more than $1 billion.

When public health initiatives are working, Zimmerman said, it's not always obvious.

"I think my biggest concern is that it's easy for us to be complacent about TB because a lot of us don't see it on a daily basis," she said. "And we're in a time when money is very tight. And when people don't see something and there's a battle of dollars, there's a tendency to cut money."

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