There's a hole in the bucket, dear Liza, dear Liza...

The latest edition of the CDC MMWR contains a document with the rather grand title;

Plan to Combat Extensively Drug-Resistant Tuberculosis
Recommendations of the Federal Tuberculosis Task Force

The reason for all this activity is, apparently, the risk of losing money;

The emergence of XDR TB raises concerns about the possibility of epidemics of virtually untreatable TB. Such epidemics could result in excessive mortality and substantial financial and infrastructure burden for public health and TB control programs. XDR TB is much more expensive to treat, with hospitalization costs in the United States estimated to average $483,000 per case. A major outbreak of XDR TB in the United States would constitute a substantial drain on public health resources and could quickly deplete the existing state and local TB budgets and have a negative impact on progress toward TB elimination

There are problems with XDR-TB, how do you differentiate between TB and drug resistant TB and in particular drug resistant TB in its latent form? (drug resistant TB is defined as TB that is unresponsive to treatment)

Problem 13
The role of public and private TB laboratories in the diagnosis of persons latently infected with XDR M. tuberculosis has not been defined clearly

Objective 13.1
Develop laboratory services to identify persons with drug-resistant latent M. tuberculosis infection (DR LTBI) (domestic).

No sooner do you identify one problem others arise

Problem 15
Limited capacity exists for the evaluation of new TB diagnostic tests

Fundamentally its the same TB story with a new twist, drug resistant TB has the potential to return the world to the pre antibiotics era.

The emergence of drug-resistant TB illustrates the pressing need .....to prevent development of active disease among persons who are infected latently with drug-resistant M. tuberculosis

This document is a wake up call to decision makers; falling rates of TB is no reason to drop funding to TB programs

There is concern that progress in TB prevention and control is waning as manifested by the decrease in the rate of decline in TB incidence since 2000. The United States responded successfully to the MDR TB problem in the 1990s and is capable of preventing and controlling XDR TB; however, this will require a united commitment and effort similar to that which occurred in 1992...The Federal TB Task Force Plan and the Global Action Plan will require a renewed commitment by all public health workers as well as new resources from both the public and private sectors.