TUBERCULOSIS

WHEREAS, the incidence of new tuberculosis (TB) infections and active cases has steadily risen to epidemic proportions since 1985. In 1990, 25,701 new active cases were reported, an increase of 9.4 percent over the 1989 figure and the largest annual increase since 1953. It is estimated that 10 million persons in the U.S. are currently infected with tuberculosis with no overt disease; and

WHEREAS, notable increases of tuberculosis have occurred among children; and

WHEREAS, nearly two-thirds of all TB cases occur among African Americans, Hispanics, Asians and Native Americans because of compromised socio-economic conditions¾poor and crowded housing, lack of access to medical care and malnourishment; and

WHEREAS, inadequate ventilation in health care facilities and prisons has resulted in several serious outbreaks of TB; and

WHEREAS, outbreaks have recently been reported in schools; and

WHEREAS, new strains of multiple-drug resistant (MDR) TB threaten community health in major urban areas. In 1990, there were MDR-TB outbreaks in four Miami hospitals and three New York City hospitals; and

WHEREAS, persons who are immunocompromised¾i.e., those who are HIV infected, persons with some cancers and diabetes¾are especially at risk for fulminant TB; and

WHEREAS, health care workers and corrections personnel are at high risk of work-related exposure; and

WHEREAS, the public health system in this country is in a state of crisis and not equipped to cope with the new TB epidemic:

RESOLVED, that AFT call for the promulgation of emergency temporary standards by the Occupational Safety and Health Administration (OSHA) that will:

• Mandate appropriate control measures in health care facilities, schools, correctional facilities and other public institutions. These measures should include adequate general dilution ventilation; negative pressure ventilation; isolation rooms with separate ventilation for patients with TB; and correctly installed germicidal ultra-violet (U.V.) lights; and

• Provide effective and necessary personnel protective equipment for workers who are at risk of exposure; and

• Provide administrative isolation and management of undiagnosed patients and individuals with respiratory symptoms of unknown etiology; and

• Provide surveillance programs with confidential, appropriate medical follow-up for those whose skin test verifies recent exposure; and

• Provide education and training programs for all workers at risk of exposure; and

RESOLVED, that AFT urge Congress to take immediate action to combat TB through increased appropriations for the Centers for Disease Control (CDC) and state public health programs; and

RESOLVED, that school surveillance programs be put in place immediately in large urban areas to ensure early identification and treatment of children who have active disease; and

RESOLVED, that voluntary school surveillance programs be offered to school staff in large urban areas where TB is endemic. Although young children with active disease pose no risk to adults and other children, adolescents and staff personnel with active TB may transmit the disease; and

RESOLVED, that a work-related presumption of infection be made for all workers in high-risk settings (hospitals, prisons and schools) who skin convert and that all costs of diagnosis, preventive therapy and other treatment be paid by workers' compensation.