COMMUNICABLE DISEASES: The Resurgence

By Natalia Williams

Young, deadly and without a cure, this 20-year-old disease has achieved, due to its pervasiveness and immense political and celebrity backing, a twisted sort of notoriety.

Use of the word "pandemic" isn't hyperbole; AIDS is everywhere, able to cross all colour, culture and class lines.

Here at home, there are estimates of 4,000 new cases of HIV each year and another 15,000 people who are HIV-positive carriers or with full-blown AIDS. Looking across the waters of the Atlantic, the affects of this disease are truly surreal level. Of the 22 million people already killed by the disease, three- quarters are from some of Africa's poorest countries.

But lurking in the dim, outside of the AIDS spotlight, are others. Other time-worn diseases like malaria and tuberculosis (TB), without the celebrity endorsement and media airtime. Once treatable, or in the very least manageable diseases, that have either stayed at high, but stable levels. Today however, these preventable diseases have once again reared their heads -- this time working in tandem with AIDS.

The reasonably-priced drugs used to combat TB are now ineffective against a new, more powerful strain of the virus; Fighting that new strain is 1000 per cent more expensive. Malaria has reemerged in areas of the world once thought cured. Often targeting children under 10, it has earned the distinction as the leading killer of Africa's children.

Now, with notions of the global community coming to fruition, they have become diseases that travel, able to cross borders as simply as it takes to board a plane. Simply,Ttey are no longer diseases that affect "them."

Over several issues, WORD will take a closer look at malaria and TB -- beyond the AIDS spotlight -- as well as the issues that surround the resurgence of these diseases in Africa and here at home.

This is a story of the other diseases.

"They don't have the same pizzazz," professor Donn Kushner says somewhat matter-of-factly.

He's comparing malaria and TB to AIDS. Trying to explain why it is rare to hear much about these diseases. A professor emeritus from the University of Toronto, Kushner specialized in infectious disease and drug resistance. "[Malaria] kills, but it doesn't kill all," he says.

"We're talking about (in some cases) 20 per cent of the population for heaven sakes, [AIDS is] the sort of thing that can wipe out whole populations. As bad as malaria has been, it hasn't done that and I don't think that it will." Still, the affect of malaria may be more insidious.

Every case of AIDS passes along, on average, about two three cases of AIDS. A case of malaria can result in as many as a hundred more cases of malaria, particularly targeting young children and expectant mothers.

Today, some 300 to 500 million cases of malaria occur every year, according to the World Health Organization (WHO), compared to about 34.4 million AIDS cases. Malaria has claimed about 2-3 million lives, AIDS about 2.8 million of which 500,000 are children. About 1.1 million children have died from malaria, about one every 30 seconds.

Transmitted by infected mosquitoes, this 8,000-year-old disease thrives in regions subject to abnormally heavy rains, long periods of increased humidity and temperatures.

Those are indigenous environmental factors particularly difficult to counteract, says Professor Kushner. "To get rid of malaria in the rain forests of Africa is very hard indeed," he says.

Dr. Mark Young, a senior health advisor at the Canadian International Development Agency (CIDA), doesn't shy away from calling both malaria and TB pandemics.

"Both TB and malaria are increasing as well," he says. "They are some very frightening global statistics."

In fact, in Canada about 1,000 cases of malaria-associated illness and deaths are reported annually. A number that, per capita, is 10 times that of the United States, and is an increase of about 140 per cent since 1994.

"Clinics and hospitals are seeing malaria more often," says Young."Malaria is something people need to be aware of."

Curing a simple strain of tuberculosis costs between $10 to $15 dollars over the eight-month treatment period. "It"'s one of the most cost-effective treatments for (any illness), Dr. Young says.

TB attacks the respiratory system and is easily spread through coughing and sneezing.

While curable, TB is a top killer of poor people, taking more than two million lives each year. Africa is particularly hard hit, with countries like Brazil, Russia and Vietnam also struggling with increased outbreaks. Here in Canada, cases of TB are becoming frequent in poorer pockets of the country and in First Nations communities.

"People know what to do about TB in many cases," says Professor Kushner. It's the process of identifying and effectively treating the disease that tends to break down, he says. Only one in four TB patients are accessing the drugs available to cure them of the disease.

In combination with AIDS, TB is now the leading killer of people infected with HIB.

"People who are HIV-positive are much more susceptible to TB because their immune systems are compromised," says Professsor KushneR.

Doctors studying the disease agree that TB can be effectively treated and prevented, but new multi-drug resistant strains make the virus more difficult to treat, and carry a price tag of between $10,000 to $15,000 dollars.

Earlier this year, a man from the Dominican Republic entered Canada carrying a multi-drug resistant strain of TB. By the time he was diagnosed, his wife and 35 other residents in the Hamilton area where infected. Health authorities needed to track down the 1,200 other people to test for TB.

A 29-year-old Canadian man was employed for 2 months as a miner in rural Zambia. The day after he returned to Canada he became feverish, had chills and a persistent cough. Despite expressing his concerns about malaria, he was diagnosed with bronchitis during a visit to the emergency department of his local hospital. On the fourth morning of his return to Canada he died. An autopsy revealed a severe case of malaria.

Immigration and air travel are helping to bring these so-called tropical diseases home. With 250,000 new immigrants entering Canada each year and 80 million border crossing by other travelers, the risk of malaria and TB within our own borders is heightened.

Lack of knowledge, unfamiliarity with the diseases and ineffective treatment structures are exacerbating the problem here in Canada and abroad. Xenophobia is also becoming a concern as government, health officials and the media struggle with how to inform the public effectively, concisely -- and without prejudice.

Today, malaria and TB are no longer other people's diseases. Says Dr. Young succinctly: "Disease knows no borders."

Produced with the support of the CANADIAN INTERNATIONAL DEVELOPMENT AGENCY (CIDA)

RELATED STORIES
The Aftermath of War in Sierra Leone The Resurgence of TB The TB Epidemic in a Borderless World
<Back to top>	Tell us what you think. word@wordmag.com