Washington Post (08/10/99) P. A1

Tuberculosis (TB), one of the world's deadliest infections, kills between 1.5 million and 2 million people a year. The rise of drug-resistant strains of TB could raise the death toll even higher. In the United States, 40 percent of new TB cases reported in 1997 were in people born in other countries, versus 22 percent 10 years before that. TB has become more of a global threat as travel has become easier and more common. While many wealthy nations can afford effective drugs and medical regimens, individuals in the developing world often cannot. An outbreak of multi-drug resistant TB in New York City in the early 1990s demonstrates that the disease still poses a considerable threat to public health. Officials have spent over $700 million in the past eight years to help control that outbreak, building an isolation ward at the city jail on Rikers Island, closing the largest homeless shelter, and hiring workers to make sure TB patients take their medicine. The World Health Organization recommends the directly observed treatment, short-course (DOTS) program, in which patients are watched to ensure their compliance with their drug regimens, but many experts assert that more than DOTS is needed to eliminate the disease. The experts say that an international effort, including surveillance of those with drug-resistant strains of TB, will be required to stem the spread of the disease. Furthermore, the international community will have to work on producing better diagnostic tests, medications, and an improved vaccine.