A casual perusal of where new TB "hot zones" are sprinkled around the world suggests Ireland should not be disturbed by a growing incidence of tuberculosis. The list includes Russia, Latvia, Estonia, India, the Dominican Republic, Argentina and the Ivory Coast. Had this trend been in evidence 30 years ago, when new, powerful drugs were available and the Irish TB scourge under control, complacency might have been excusable. But not today.
The difference between then and now is international travel and new strains that cannot be cured by what were once considered wonder drugs. Resistance to individual drugs has increased in recent years. Now more and more drug combinations don't work. That is the form of multi-drug resistance tuberculosis (MDR-TB) which is worrying the World Health Organisation.
The disease is caused by bacteria being passed from person to person by coughing or sneezing. It usually affects the lungs, where the bacteria cause holes. Symptoms include coughing, sometimes bringing up blood, chest pain, exhaustion, fever, profuse sweating at night and weight loss.
It is estimated that 1.7 billion people worldwide are infected, and eight million active cases develop annually, leading to 2.7 million deaths.
A respiratory physician, Dr Luke Clancy of Peamount Hospital, Dublin, put MDR-TB in context: "People might say, I'll never be in any of those countries. That does not mean nobody from here will be there. With the increase in international travel, the likelihood of meeting MDR-TB increases."
Moreover, there are already MDR-TB cases here, albeit at a level of less than 1.5 per cent of all TB cases, which totalled 453 last year.
It usually takes about six months to treat TB. With MDR-TB, the chances of being cured are greatly reduced, and treatment is much longer, very expensive and more toxic for patients, Dr Clancy said. But treatment, he believes, is possible with the right specialists and treatment strategies.
"Ireland has between five and 10 cases (MDR-TB) a year. We know they will increase. It's inevitable. But if we are ready for it and maintain our services, we will be able to deal with it."
Ireland did not curtail its TB services when cases were declining. New York State fell into that trap during the 1980s. "It cost $700 million to reverse the trend [of increasing TB]," Dr Clancy said.
The DOTS strategy - ensuring religious adherence to the drug regime - has been in operation in Ireland for 20 years. The Department of Health has reinforced that strategy by an agreed TB treatment approach and a working party, set up in 1992, which is monitoring MDR-TB.
The new strains, HIV-related TB and immigrant patterns are considered key areas to be monitored for globally increasing tuberculosis.
A respiratory consultant, Dr Charles Bredin, of Cork University Hospital, said the MDR-TB problem is "very confined" within Ireland.
Before the introduction of streptomycin and isoniazid drugs in the late 1940s, diagnosis of TB was almost certainly a death sentence. Almost 10,000 Irish people died between 1950 and 1960. Health authorities warned of the perceived dangers of spitting. Fear and ignorance surrounded the virtual epidemic. It prompted a radical overhaul of Irish health care.
Before the new drugs became available, treatment was largely unsuccessful. Mutilating chest operations often resulted in gross deformity and respiratory disability, but exponents believed they saved some lives.
A sustained decline in cases resulted from improved health care, better socio-economic conditions and more appropriate intervention. Most of all, new drug combinations made TB curable.
By the 1980s, nonetheless, Ireland had the highest incidence in the then EEC.
By the 1990s, HIV-linked tuberculosis provided another reminder that TB remained a global problem and was far from eliminated. Multi-drug resistance raises the spectre of "virtually incurable" strains.
To those who fear a resurgence, Dr Clancy said: "If we maintain services and the infrastructure we have in place, I'm confident that we can deal with it. We really can."