Migrants Bring Multi-Drug Resistant TB to Wisconsin

Two refugees and a foreign student on a visa brought multi-drug resistant (MDR) tuberculosis (TB) to Milwaukee, Wisconsin in 2009 and 2011, according to a 2014 article in an epidemiology publication written with the cooperation of the doctors who treated them.

The introduction of MDR TB to the United States represents a serious public health threat, since its successful treatment is uncertain and very expensive. Active TB can usually be treated successfully in six to nine months at a cost of $17,000 per patient, according to the Centers for Disease Control (CDC), but MDR TB treatment costs more than $150,000 per patient and can take between 20 and 26 months.

The six to nine month treatment regimen for active TB, which has been standard practice in the United States for some 50 years, involves a combination of four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol.

Over the past several decades, new strains of TB have developed around the world which are resistant to at least two of these four drugs, hence the term MDR TB. Treatment for MDR TB begins only after the patient is observed to be resistant to the standard four drug protocol. Subsequent to diagnosis, a number of expensive “second level” drugs are added to the patient’s treatment regimen.

Twenty cases of MDR TB, all foreign-born, were diagnosed in Wisconsin over the eight year period between 2005 and 2012, according to the Wisconsin Department of Health Services.

Twelve of these cases were from the Hmong people in Laos (though Case 2 in the 2014 article was categorized as “drug resistant,” not formally MDR-TB, it was probably included among these 12, as well as Case 2’s “close household contact”), four were from India (including Case 3 from the 2014 article), one was from Burma (including Case 1 from the 2014 article), and one each were from China, Ethiopia, and Nepal.

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