Fresno Bee (02.06.13)
Public health officials in California’s central San Joaquin Valley are limiting tuberculosis (TB) treatment in three counties because of a nationwide shortage of isoniazid, a common anti-TB drug. The three California counties are Tulare, Kings, and Fresno, where only persons with active TB can obtain the necessary drug from health departments. Madera County has an adequate supply. Health officials say it could be April before isoniazid is once more in ample supply. On February 5, the US Food and Drug Administration stated that the shortage is being resolved. Meanwhile, Valley health officials are prioritizing who receives isoniazid.
Persons with asymptomatic or latent TB will be treated only if they are at high risk of developing the disease, such as those with weakened immune systems; however, delaying treatment for latent TB generates a concern that people will not return for help once the drug becomes available. Health officials worry that hundreds of people in the Valley could be affected. Persons can be exposed to TB germs and not be ill; nevertheless, the latent form of TB can progress and cause illness.
County health departments treat most people with TB, and by limiting isoniazid to active TB patients, the counties hope to have adequate amounts of the drug to last through the shortage. Approximately a year ago, Madera County started buying and dispensing isoniazid itself, according to Van Do-Reynoso, the county’s public health officer. The local pharmacy that the health department had used is now out of the TB drug, she said. Dr. Kenneth Bird, Fresno County’s TB control officer, explains that Fresno County should have an adequate supply of the drug as long as the shortage does not extend beyond April. Tulare County health officials are prioritizing cases to extend their limited supply of the drug. The California Department of Public Health is monitoring the shortage, and the state Tuberculosis Control Branch is working with local programs to help secure the drug and to offer information about availability. Valley health officials said they have planned for the shortage of isoniazid to April. The health officials state they will use rifapin, an alternative drug. Erica Lessem of the Treatment Action Group, a New York-based non-profit HIV research advocacy organization, notes, however, that an alternative drug can be 10 times more expensive than isoniazid, creating a problem for budget-stretched public health departments. Also, Dr. Michael McLean, health officer for Kings County, adds that rifapin interacts with other drugs and is not easily tolerated by patients.