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Do you recall the case of the man who got in trouble last year for traveling by airplane because he had drug-resistant tuberculosis (TB)? "I kind of remember hearing about him," says Joann C., a 16-year-old from Norwalk, Conn. "I know what TB is, but I don't really

Fourteen-year-old Spencer M. of Bridgeport, Conn., says that TB has never been discussed in his health class, so what he knows about it comes from less reliable sources: "I know that TB is a disease, but I don't know what type it is. I don't know anyone who has gotten it, except for people in TV shows." Exactly what is TB, and why is it such a big deal?

TB Tutorial

Tuberculosis is a bacterial disease that usually affects the lungs but also can attack other parts of the body. Symptoms can include a cough that doesn't go away and brings up blood. Not everyone with TB bacteria has a full-blown case, however, just as not everyone infected with HIV goes on to develop AIDS. (See "TB: Infection or Disease?")

Only one-fourth of those infected are ever diagnosed. But teens infected with TB are more likely to develop the disease than children or adults. That's largely because of changes in hormones and metabolism that all teens experience.

Tuberculosis has been around for a long time--scientists recently discovered that a 500,000-year-old fossil contained evidence of the disease. (See "History of TB.") More than 1.6 million people worldwide die each year from TB. However, it is well controlled in the United States; in 2005, TB caused 646 deaths and infected four out of every 100,000 teens and young adults. Tuberculosis is usually treatable with a few months to a year of antibiotics.

Something in the Air

So how does someone catch TB? The bacteria can spread through the air when people who are infected cough, laugh, sneeze, sing, or even talk. "TB is not like colds or flu--it's not that infectious. Even those who live with an infected person are not often infected themselves," explains Dr. Robert England, director of the Maricopa County Department of Public Health in Arizona. "You're not at risk of getting TB if someone with TB coughs in your face. You're more at risk when you walk into a room and someone with TB has been coughing for hours." Or sitting near you on an airplane.

Andrew Speaker, the lawyer from Atlanta who was infected with TB, caused an international scare in the spring of 2007. He ignored the advice of health officials and flew to Europe for his wedding--thereby putting many people on the flight at risk of contracting TB. What's more, Speaker was infected with a form of TB that is highly resistant to many types of drugs. Thankfully, tests later showed that no one on Speaker's flight became infected.

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Keeping It at Bay

While the form of TB that Speaker had is quite serious, he was treated successfully. But there's an even more dangerous form of TB that some experts feel may become virtually untreatable in the future, resulting in a worldwide health epidemic on a par with AIDS. Neither type is as common in the United States as it is in other parts of the world, mainly due to economic factors and U.S. health officials' vigilance.

Because of this threat, health officials worldwide have boosted efforts to fight TB, from stepping up research on vaccines to restricting travel for those infected. Just months after Speaker's story made headlines, a woman was hospitalized with drug-resistant TB after flying from India to California. And a teen in Georgia was jailed after he refused to be treated for TB and threatened to go to Mexico.

Since teens infected with the bacteria are more likely to develop the disease, many states and communities have set up plans to deal with this situation in schools. For example, this past February, a student at Trevor Browne High School in Phoenix tested positive for TB infection. Health officials recommended testing 120 other students who might have come in close contact with the teen. Letters went out to parents of all the students in the school to explain the situation and prevent panic.

"You want people to keep things in perspective," says England. That's good advice. While TB is a major problem in other parts of the world, it's not something most Americans need to worry about anytime soon. But as the Andrew Speaker case showed, you can't be too careful. If more bugs learn to get around the drugs, watch out!

History of TB

500,000 B.C. (approx.)

Earliest evidence of TB in humans

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460 B.C.

Hippocrates identifies phthisis (TB) as most widespread disease.

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1839

J. L. Schonlein names the disease tuberculosis,

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1859

First TB sanatorium (to isolate patients with TB from the public) opens in Poland.

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1882

Robert Koch discovers TB bacteria (Mycobacterium tuberculosis).

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1906

Albert Calmette and Camille Guerin develop the first TB vaccine.

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1946

Selman Waksman develops first TB antibiotic, streptomycin.

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1980s

TB on the rise, coinciding with arrival of AIDS

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1993

World Health Organization declares TB a global health emergency.

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2007

Atlanta lawyer Andrew Speaker causes worldwide health scare by flying overseas with a drug-resistant form of TB.

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TB: Infection or Disease?

There is a difference between being infected with tuberculosis (TB) and having the disease TB. Someone who is infected with TB has the bacteria, but the body's defenses are protecting him or her from getting sick. However, someone with TB disease is truly sick, can spread the disease to others, and should see a doctor as soon as possible. He or she may have some of the following symptoms:

* A persistent cough

* Constant fatigue

* Weight loss

* Loss of appetite

* Fever

* Coughs that bring up blood

* Night sweats

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Before Reading

* Ask students what they know or have heard about tuberculosis (TB).

Discuss

* How does TB infection differ from TB disease? (People who have only the infection do not suffer any symptoms. People who develop TB disease can become very sick and can pass it on to others.)

* How is TB spread? (through prolonged exposure to a person with TB disease)

* Why do you think health officials consider TB a serious public health problem? (Answers will vary.)

* Do you agree with Andrew Speaker's actions? Why or why not? (Answers will vary.)

Resource

* KidsHealth www.kidshealth.org/teen/ infections/bacterial_viral/ tuberculosis.html