Gothamist Health wants to wish everybody a happy World Tuberculosis Day 2005! And when you go out tonight to celebrate, you can eat, drink, and be merry knowing that tuberculosis rates have reached an historic low with only 1,039 cases reported in New York City in 2004. This is a 73% decline since the peak of TB in NYC in 1992. Although the decline is something for our friends at the NYCDOH to be proud of, NYC still has about double the national rate of TB. NYC is the very definition of an immigration melting pot and, unfortunately, TB disproportionately affects immigrants. Sixty-eight percent of all cases of TB were found in foreign-born New Yorkers and most were from either China, Ecuador, Dominican Republic, Haiti, Mexico, or India. TB is passed from person-to-person via micro-droplets exhaled from people infected with TB and usually requires prolonged exposure in enclosed spaces.
Although the folks at the NYCDOH are partying hard on World Tuberculosis Day 2005, WTD 2006 might be a bit disappointing. Not to be a cynic, but nearly every infectious disease known to man has a certain background rate in the population that cannot be altered short of vaccinating every human being on earth. Considering the numbers of immigrants here in NYC and the fact that Science has not given us a reliable vaccination against TB, we might be at the lowest rate of TB possible. The NYCDOH has done a great job intervening in the spread of TB specifically through Directly Observed Therapy, in which a health worker observes and records every dose of anti-TB medication that a patient takes.
The NYC Health Code was updated in 1993 permitting the commissioner of health to issue orders compelling a person to be examined for suspected tuberculosis, to complete treatment, to receive treatment under direct observation, or to be detained for treatment. For all those who are old enough to remember 1993, you may recall the stink raised by some civil liberties groups questioning these new powers as a means of social control. Some believed these new regulations unfairly pertained to those individuals who lacked adequate housing, primary health care, and services for substance abusers. Some cried foul that this was an attempt by the NYCDOH to discriminate against people with HIV.
And all of you who were alive back in 1904 might remember the Supreme Court case of Jacobson v. Commonwealth of Massachusetts in which Henning Jacobson was fined $5 for refusing to be vaccinated against smallpox while Cambridge was in the midst of a smallpox outbreak. Reverend Jacobson was a man of principle and took it all the way to the top in order to get back his five dollars. But the Supreme Court decided that states may limit individual liberty in the service of well-established public health interventions. The Jacobson case has been cited in numerous other decisions such as the Supreme Court case in 1927 of Buck v. Bell where Justice Holmes stated "the principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes." Talk about a slippery slope! First you are required to be injected with the pus from a blister on a cow with cowpox, then your Fallopian tubes are cut because you are promiscuous, raped, or deemed a bit mentally dull.
Hopefully our society has advanced a bit (Our leaders condemn torture, right?) and we don't have to worry about Dr. Frieden at the NYCDOH slipping on any slopes. Congratulations to him and his team for making NYC a healthier place to live. And stop holding your breath when you ride an elevator with a homeless person -- you might pass out, hit your head, and die.