Will Texas Protect Infants from Tuberculosis

A worldwide health issue has recently accelerated in Texas, potentially exposing hundreds of people to an airborne disease. In 2021, the World Health Organization (WHO) confirmed about 10.6 million people fell sick with Tuberculosis (TB), and 1.6 million died.

And in Texas, there were 998 TB cases in 2021, a 12.5% increase in one year.

More than any other population, Hispanics (52.1%) reported the most TB cases in Texas, with about 61% being born outside of the U.S.

And in Harris Country, which includes the city of Houston, there were 235 TB confirmations.

When a person with TB disease of the lungs or throat coughs or speaks, the bacteria disperse into the air, says the WHO.

This means people, including infants, may breathe in TB bacteria and become infected.

While TB is curable with appropriate treatment, some strains of TB are resistant to drugs used for treatment.

Texas did confirm eight people were diagnosed with multidrug-resistant TB in 2021.

Many countries shared these concerns and led the WHO to announce an innovative TB prevention strategy last week.

The WHO's Director-General, Dr. Tedros Adhanom Ghebreyesus, stated on January 17, 2023, "The challenges presented by TB and COVID-19 are different, but the ingredients that accelerate science, research, and innovation are the same: urgent, up-front public investment; support from philanthropy; and engagement of the private sector and communities."

"We believe the TB field will benefit from similar high-level coordination."

To support the rationale for immediate action, the WHO commissioned an investment case study in 2022 for new TB vaccines.

That study estimated over 25 years, a vaccine that is 50% effective in preventing TB among adolescents and adults could avert up to 76 million new TB cases, 8.5 million deaths, 42 million courses of antibiotic treatment, and US$ 6.5 billion in costs faced by TB-affected households.

Until new vaccines become available, the 100-year-old Bacillus Calmette–Guérin (BCG) vaccine is available and used by many countries with high rates of TB.

And this U.S. FDA-approved vaccine costs less than one dollar.

The WHO says the BCG provides moderate efficacy in preventing severe forms of TB in infants and young children.

But it is not generally recommended in the U.S., in Houston, Texas.

The U.S. Centers for Disease Control and Prevention says the BCG vaccination should be considered for children who have a negative TB test, who are continually exposed, and who cannot be separated from adults that are:

• untreated or ineffectively treated for TB disease,
• the child cannot be given long-term primary preventive treatment for TB infection,
• has isoniazid- and rifampin-resistant strains of TB disease.

To verify how accessible the BCG vaccine is in Houston, Precision Vaccinations contacted Harris County Public Health and Kelsey-Seybold Hospital.

The Harris County Public Health TB Elimination Program offers various TB prevention and control services. But the local health department was unclear if the BCG vaccine was being offered to children living with TB patients in 2023.

And Kelsey-Seybold's vaccination clinic confirmed they do not offer BCG vaccines to anyone in the greater Houston area, which encompasses about five million residents.

Furthermore, children moving to TB-endemic areas can't get the BCG vaccine from Kelsey, a leading travel vaccination provider.

While TB treatments are very effective, the WHO's recent efforts focus on eliminating TB health risks in children early in life.