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TB jail led to lowest rate in years

30th June 2006

Around the globe, especially in third world countries, tuberculosis is rampant, killing roughly two million people annually.

But in the United States, tuberculosis, following an epidemic in New York in the early 1990's, is at its lowest rate in decades, with only 989 cases reported in 2005.

Rates of the disease — most often a lung infection that is communicable from person to person — had greatly accelerated in several American cities. In New York, there were 3,811 new cases in 1992, up from 1,514 cases in 1980.

New York health officials took an active approach, getting as many patients as possible on directly observed therapy, in which outreach workers administered TB medications in clinics, patients’ homes and on the street.

For patients who failed, the health department employed forcible detention, sometimes known as TB jail. More than 250 patients were detained between 1993 and 1998, some for as long as two years.

This tough love approach seemed to work. By 2001, new cases of TB dropped to 1,261. The courts that conducted routine hearings on the detention cases overwhelmingly decided in favor of the city.

There is surely a concern that detention may be used inappropriately, as TB most often afflicts the poor and minorities. But every detained patient is assigned a lawyer. And there is more acceptance than anger among the patients, whose good behavior is rewarded with various incentives, like art therapy, Chinese food, exercise facilities and, at times, early discharge.

 

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