Tuberculosis is different, in a very dark, utilitarian way. 4% of new TB cases are multi-drug resistant (19% of recurrences).
Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.
Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.
They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.
TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework.
if you feel the urge to fight this: i lived with someone infected with TB.
A single, untreated person with TB will infect 1.5 to 4 people if public health interventions don’t happen. Measles sits at 12 to 18 people per infected person.
In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
Depends heavily on whether we're measuring in practical terms, or in "no medical intervention" terms.
If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious.
If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio.
Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does.
I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt.
> i lived with someone infected with TB.
If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.
re TB: you think i wouldn't know? and it was found because it was active.
re eradicating measles: the terrain is much more complicated than presented. first, because the vaccine fades away, and without measles spreading in the young population, adults don't get natural reminders, and eventually there can be a big wave without poking everyone. and the disease is much more dangerous for adults. and all this unnecessary trouble for a disease that is not really dangerous when left alone and the population is not malnutrished.
and there's that cancer thing with measles, just to shed some light on the complexity:
MEASLES: Albonico et al found that adults are significantly protected against non-breast cancers — genital, prostate, gastrointestinal, skin, lung, ear-nose-throat, and others — if they contracted measles (odds ratio, OR = 0.45), rubella (OR = 0.38) or chickenpox (OR = 0.62) earlier in life. [Med Hypotheses 1998; 51(4): 315-20].
https://www.ncbi.nlm.nih.gov/m/pubmed/9824838/
MEASLES: Alexander et al found that infection with measles during childhood is significantly protective — it cuts the risk in half — against developing Hodgkin’s disease (OR = 0.53) [Br J Cancer 2000; 82(5): 1117-21].
Measles to the Rescue: A Review of Oncolytic Measles Virus.
MV Clinical trials are producing encouraging preliminary results in ovarian cancer, myeloma and cutaneous non-Hodgkin lymphoma, and the outcome of currently open trials in glioblastoma multiforme, mesothelioma and squamous cell carcinoma are eagerly anticipated.
Aref S, et al. Viruses. 2016.
Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.
Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.
They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.
TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.