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Cablegate: Can Taiwan Eradicate Its Tb Problem?

VZCZCXYZ2484
RR RUEHWEB

DE RUEHIN #0284/01 0630825
ZNR UUUUU ZZH
R 030825Z MAR 08
FM AIT TAIPEI
TO RUEHC/SECSTATE WASHDC 8234
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 7878
RUEHUL/AMEMBASSY SEOUL 9363
RUEHKO/AMEMBASSY TOKYO 9619
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS AIT TAIPEI 000284

SIPDIS

SENSITIVE
SIPDIS

HHS PASS CDC MARK ABDOO

E.O. 12958: N/A
TAGS: AMED AMGT CASC ECON SENV SOCI TBIO TW
SUBJECT: CAN TAIWAN ERADICATE ITS TB PROBLEM?

1. (SBU) SUMMARY. Tuberculosis has been recorded in
Taiwan since the early 20th century and successive
administrations have tried to control this scourge. TB
infects about 15,000 persons per year in Taiwan and 1,300
people die from it every year. Treatment is a major
challenge, given the rigorous treatment regime with high
doses of antibiotics. Three years ago, Taiwan health
authorities made a strategic decision to disband its
provincial level TB treatment center and let local clinics
handle TB treatment. This resulted in TB experts being
disbanded and the TB combating effort diluted. Taiwan has
the technical expertise to handle TB but is hobbled by a
less-than-efficient organization. Taiwan's Centers for
Disease Control, (CDC), an adjunct of the Department of
Health, is actively seeking ways to eradicate the disease and
hopes to reduce TB rates in Taiwan by half by 2015, but its
anti-TB effort is driven by administrators with little
experience in TB treatment. END SUMMARY


BACKGROUND
----------

2. (SBU) Tuberculosis records have been kept in Taiwan since
the early 20th century (during the Japanese occupation),
although the disease was probably around for much longer.
Because TB bacteria can survive in the air for up to three
months, infected people pose a particular threat to others by
coughing and spitting. TB is the 12th leading cause of death
in Taiwan, and although it has not attracted the attention
that SARS has, its persistence and difficulty in treating are
drawing concern from health authorities. Postwar data from
CDC indicates that the mortality of TB was 294 per 100,000
(compare with current mortality rates of 4.3 per 100,000).
The elderly above 65 account for 60 percent of the patients
and mortality increases with age. However, lower mortality
rates do not imply that the infection rate has dropped
drastically, only that drugs have managed to control the
disease and make it less lethal. In Taiwan, aborigines are
four times more susceptible to becoming infected with TB
because they don't have easy access to medical care and the
authorities have made efforts to correct that by providing
subsidies and medical teams to the mountain areas to provide
X-rays.

CONNECTING THE DOTS
-------------------

3. (SBU) Directly observed treatment Short Course (DOTS) is
a TB management system developed by the World Health
Organization (WHO) and widely used for regular TB and drug
resistant TB ( MDR-TB). The DOTS program, administered by
the CDC is locally monitored by more than 400 outreach
workers from local health units who daily monitor patients to
ensure that the drugs are taken as prescribed. This is
inadequate for the large number of TB sufferers who are over
65 years old. DOTS was first implemented in Taiwan starting
2006 and targeting of MDR-TB started in 2007. Taiwan has 427
MDR-TB cases and a total TB population of 150,000. MDR-TB
has developed resistance to antibiotics largely because
patients that are treated are not taking the drugs on a
regular basis allowing the bacteria to develop drug-resistant
strains. According to news reports, 10-13 percent of
patients are afflicted with MDR-TB posing special challenges
to disease prevention experts at CDC. This is a perennial
problem with TB treatment, where drug induced discomfort
discourages people from staying on the drug treatment regime.
To medical experts, it is crucial that treatment regimes are
followed and monitored under a strict program. That used to
be the case, according to Dr. Lin Taoping, head of the
National Tuberculosis Association (NTA), an NGO which gets
funding from CDC. Lin headed the Provincial TB treatment
center which combined medical expertise with systematic
monitoring and research. When his center was disbanded,
apparently to save money (but also for political reasons as
provincial organizations were done away), his medical experts
went to work at local clinics and did not have the extensive
support system that took so long to build up.

MONITORING AND DATA UPDATES-A CAUSE FOR CONCERN
--------------------------------------------- --

4. (SBU) ESTH officer visited Dr. Cynthia Yang (Chin-hui),
who is in charge of the TB/AIDS program at CDC. Yang said
once a patient is diagnosed with TB, they are put on a
monitoring list and local health officials trace the
patient's drug intake and progress throughout the treatment
period using the DOTS program. A list of actively treated
patients is submitted to the immigration bureau to ensure
that their whereabouts are monitored. According to Yang,
Taiwan's TB infection rate is dropping at the rate of 5
percent a year. In mid-July 2007, a couple who were
undergoing TB treatment (one of whom was a MDR-TB case)
absconded to mainland China in defiance of a travel ban. PRC
authorities eventually traced them to Jiangsu province and
arranged for them to fly back. In spite of the patients'
names being registered on the CDC watchlist, loose
enforcement let them slip unnoticed from Kaoshiung to the
mainland. According to information from NTA, CDC discovered
later that the person monitoring this couple had checked off
the days the couple were supposed to have taken the medicine
in Taiwan although they were in the mainland (!). The couple
were fined NT$150,000 ($4,800). In another case late last
year, a passenger was denied boarding even though he was not
contagious and had been cleared by the medical personnel at
NTA. In that incident, CDC head Steve Kuo personally went to
the airport and after verifying the records noticed they had
not been updated (the passenger was allowed to board in the
end). Lin lamented that with the CDC staffed with
administrators with little background in TB treatment, yet
are tasked with drastically reducing the incidence of TB.

COMMENT:
--------

5. (SBU) Given the success in Taiwan of eradicating
malaria, smallpox and other diseases, hope remains that TB
will eventually be wiped out. But the incubation period of
the disease, its long term survivability in the environment,
its drug resistance and difficulty of monitoring potential
carriers all pose tremendous challenges for its management.
Lack of expertise, personality-driven management and lack of
a systemic approach to combat TB among disease control
authorities, all contribute to the difficulty in eradicating
TB. It is no wonder that new TB patients are popping up at
the rate of 15,000 a year. With 150,000 afflicted persons
island-wide, reducing the incidence of new cases is a more
realistic goal, rather than lofty goals aiming at reducing in
half those infected with TB. END COMMENT
YOUNG

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