US: 3 Valley counties deal with tuberculosis drug shortage

Only people with active TB are assured of getting the drug by health departments in Fresno, Kings and Tulare counties. Madera County has an ample supply.

Valley health officials said it could be April before supplies of the drug isoniazid return to normal. The federal Food and Drug Administration said Tuesday the shortage is being resolved.

In the meantime, Valley health officials said they are prioritizing who receives isoniazid, which often is abbreviated as INH.

People with latent or asymptomatic tuberculosis will be treated only if they are at high risk of developing the disease, such as those with weakened immune systems.But delaying treatment for latent TB creates a concern that people will not return for help once the drug becomes available. Hundreds of people in the Valley could be affected, health officials said.

"A lot won't come back, so you're going to lose contact with some of them," said Dr. Michael Maclean, health officer for Kings County.

People can be exposed to TB germs and not be ill, but the latent form of the disease can progress and cause illness.

Tuberculosis is caused by bacteria spread through the air when a person with active infection in the lungs or throat coughs, sneezes or talks. It typically requires close and prolonged contact to become infected.

Tuberculosis symptoms include feeling sick or weak, weight loss, fever, night sweats, persistent cough, chest pain and coughing up blood.

Tuberculosis cases have dropped in the Valley and statewide since 2003, when the state had 3,227 cases and Fresno County had 115 cases. But it continues to be a problem: In 2011, California had 2,317 cases and Fresno County had 46 confirmed TB cases. Tulare County had 20 cases, Madera County had 12 cases and Kings and Merced counties had six cases each.

Most people with TB receive treatment at county health departments, and by limiting isoniazid to active TB patients, the counties hope to have enough of the drug to wait out the shortage.

Madera County's internal pharmacy is well-stocked, said Van Do-Reynoso, the county's public health officer, and the county is not limiting the drug to active cases only.

About a year ago, the county switched to buying and dispensing the drug itself, Do-Reynoso said. The local pharmacy the health department had used is out of the TB drug, she said.

Fresno County should have enough of the drug -- if the shortage doesn't extend beyond April, said Dr. Kenneth Bird, the county's tuberculosis control officer.

The county treats about 95% of active TB disease so the shortage likely is not affecting private providers with TB patients, he said. "It's our drug supply that we're really most worried about."

In Tulare County, health officials are prioritizing cases to extend their limited supply.

The shortage is being monitored by the California Department of Public Health, which "does not know of any patient with active TB that has gone without medication due to the shortage," spokesman Ronald Owens said.

The state Tuberculosis Control Branch is working with local programs to help secure the drug and to provide information about availability, he said.

According to the Treatment Action Group, a nonprofit HIV research advocacy organization based in New York, the supply problem for isoniazid began with a disruption at the plant where the active ingredient for the drug was made. Three main manufacturers have had difficulty getting the source material needed for the drug, said Erica Lessem, Treatment Action Team assistant director of the TB/HIV Project.

The FDA said two manufacturers, Teva and Sandoz, released isoniazid last week.

But Valley health officials said they have made plans for the shortage of isoniazid to last until April. Those plans include using rifampin, an alternative drug.

Rifampin interacts with other drugs and is not easily tolerated by patients, Maclean said, but he has started a young girl on it. "If I have to wait until April, when supposedly the (isoniazid) supply problem will be fixed, I would have to repeat her chest X-ray."

An alternative drug, rifapentine, also can be 10 times more expensive than isoniazid, which is a problem for budget-stretched public health departments, Lessem said.

The isoniazid shortage "ties the hands of health departments from being able to prevent TB disease," she said. "It's really their only good tool right now."

Note: The original version of this story had an incorrect spelling for rifampin and did not name the other alternative drug, rifapentine.

Source: The Fresno Bee