Epidemiology Paper: Tuberculosis

Tuberculosis (TB) is a communicable disease that is the “second leading infectious disease cause of death in adults worldwide (only HIV/AIDS exceeds it).” (“Tuberculosis History”, n.d) Tuberculosis is a bacterial infection that has been known to us since ancient times. Some genetic studies have suggested that tuberculosis has been present for at least fifteen thousand years. We have found evidence of tuberculosis within humans’ dating back to 2400-3400 B.C. Remains of mummies have been found to have evidence of tuberculosis inside of their spines. The term Hippocrates/consumption was created by phithis some time around 460 BC, because of the significant weight loss associated with the disease. Although TB was affecting many people in that era of time unfortunately the cause of tuberculosis was unknown.(“Tuberculosis History”, n.d) For many centuries the cause of tuberculosis was a complete mystery, It was not until the 17th century where light stated shining on this mystery. The anatomical and pathological descriptions of tuberculosis start to make its way inside some of the medical literature. The contagious nature of TB as a disease was suspected very early on when Girolamo Tracastoro wrote “that bed sheets and clothing of a consumptive could contain contagious particles.” (“Tuberculosis History”, n.d) In the year 1720, Benjamin Marten was an English physician who first suspected that tuberculosis could be caused by small living creatures and that by coming into contact with someone infected a person could also contract the disease.(“Tuberculosis History”, n.d)

Tuberculosis is a very tricky disease caused by a bacterium known as Mycobacterium tuberculosis. “The most common site of infection is the lung, but other organs may be involved.” (Center for Disease Control [CDC], 2017) The interesting thing about TB as a disease is that it can be active as well as inactive also known as latent state. During the active state it is very contagious and contact with people should be avoided. People with the latent TB infection (an infection without active disease) have no symptoms. The symptoms that can be found from TB are Fever, Chills, Night sweats, Cough, Loss of appetite, Weight loss, Blood in the sputum (phlegm) and Loss of energy. “TB can be contracted through inhaling of tiny droplets from a coughs or sneezes of an infected person. The spread of tuberculosis is promoted by several factors overcrowding, living in close quarters like in orphanages, and prisons. The presence of any existing medical problems also can be a factor. Other medical problems that raise the risk of getting tuberculosis include malnutrition, alcoholism, the presence of other infections like HIV infection that suppresses the immunity, Babies and the elderly are at a greater risk due to their ill-developed and declining immune system respectively.” (Mandal, 2018)

The tuberculosis epidemic impacts various demographics. “Tuberculosis affects mid aged adults more than any other group. Although, TB can hit any age group. About 95% of cases and deaths are in third world countries. One million children between the ages of 0–14 fell ill with TB. Two hundred thirty thousand children which also includes children with HIV associated TB died from this terrible disease in 2017”. (“Tuberculosis”, n.d)

In 2016, Ten million people around the world became sick with TB disease. There were One million seven hundred thousand TB-related deaths worldwide. A total of nine thousand two hundred seventy two TB cases (a rate of 2.9 cases per 100,000 persons) were reported in the United States in 2016. This is a decrease from the number of cases reported in 2015 and the lowest case count on record in the United States. The case rate of 2.9 per one hundred thousand persons is a 3.6% which is a decrease from 2015. We in the United States continue to make slow progress but the current strategy is not enough to reach the goal of TB elimination within this century. The CDC estimates that about fourteen percent of U.S. Tuberculosis cases with genotype data are attributed to recent transmission. Differentiating the numbers of cases associated to recent transmission from those likely due to resurgence of longstanding, untreated latent Tuberculosis infection is one of many tools state and local TB programs can use to design and engage effective public health interventions. (CDC, 2017)

Tuberculosis is a reportable communicable disease. Any person knowing of a suspected or confirmed case of TB should report it to the designated department or officials within twenty-four hours. Anyone person having knowledge or reason to believe that someone has a communicable disease shall report all the facts to the local health officer or the department of Health. Only Specific Persons or Entities are Required to Report suspected or confirmed cases of tuberculosis such as healthcare provider (defined as any doctor of medicine, of osteopathy, or of dental science, or a registered nurse, social worker, doctor of chiropractic, or psychologist licensed under [state licensure code], or an intern, or a resident, fellow, or medical officer licensed under [state licensure code], or a hospital, clinic or nursing home and its agents and employees, or a public hospital and its agents and employees) laboratory, board of health or administrator of a city, state or private institution or hospital who has knowledge of a case of confirmed tuberculosis or clinically suspected tuberculosis. (CDC, 2017)

There are many determinants of health when it comes to Tuberculosis “as well as a broad array of socioeconomic and demographic factors that determine the risk of exposure to these factors, such as income, education, gender, age and ethnicity. Further “upstream” in the causal chain, both the first-level risk factors and their second-level socioeconomic determinants are linked to public health policy, environmental policy, health systems policy and socioeconomic policy as well as to various societal phenomena such as demographic transition, urbanization, and globalization.” (Hargreaves, et al., 2011)

According to Hargreaves, et al., 2011, identifying the multiple levels of casual factors opens up for a range of potential areas of interventions, including:

• Assistance to strengthen the specific public health programs that target the risk factors directly (such as special programs on HIV, smoking, malnutrition, indoor pollution, etc.).

• Contribution to health systems strengthening to improve implementation of public health programs as well as to improve clinical care and health education for people with conditions that may increase the risk of TB (HIV, diabetes, nutritional deficiencies, etc.).

• Advocacy for improving public health policy and legislation, environmental policy, and socioeconomic policy.

The epidemiologic triangle as it relates to tuberculosis is characterized as a model that scientist have developed for examining health issues. This model can help people understand infectious disease and how they are spread from one host to another. The triangle has three corners called vertices, which are labeled Agent, Host, and Environment. An agent is considered the microbe causing the disease. The host is the organism that coves a disease, and the environment consists of any foreign factor which cause and allow conveyance of the disease”. (CDC, 2017) The fundamental factors in the epidemiology triangle of TB are:

• Agents: -Is deemed the cause of the disease which in our case is the bacterium called Mycobacterium tuberculosis.

• Host: – Can be labeled as the ‘who,’ Humans are the host that TB infects.

• Environmental factor: -The Place’s where the situation allows the transmittal which include overcrowding, poor ventilation, malnutrition, and poverty.

The governing bodies have created unique considerations or notifications for community, schools, and the general population once any confirmed case of TB has been verified. “People who have had a frequent, prolonged and close contact in an enclosed environment with an infectious person such as all people living in the same dwelling, relatives and friends who have frequent, prolonged and close contact and work colleagues who share the same indoor work area on a daily basis.” (“Tuberculosis (TB)”, n.d) Those people would be counseled and referred for assessment.

The community health nurse has specific vital roles and activities when it comes to controlling and preventing TB such as Patient care, Health education: patient, family, and community, Treatment observation, Sputum collection, Management/Coordination, Contact tracing/Screening, Research, and Teaching. The nurse’s role is a very important one when it comes to controlling TB and for the successful completion of the patient’s therapy. Once a diagnosis has been made, the patient needs to be established on the correct treatment. Home visits are the best way of making a holistic assessment of the patient’s needs and progress. Many patients have other problems, such as accommodation or immigration issues, which are often their main priority. Patients often need help to deal with these more immediate difficulties before they consider taking anti-TB medication and attending hospital appointments. The TB nurse specialist may be required to liaise with social services, the Home Office, and the National Asylum Support Service. Many patients find the treatment course difficult at the start because they have to take many tablets, some of which are very large and have various side-effects. Later, when symptoms have resolved, but the patient still has the disease, they may question the need for continued treatment. TB nurse specialists can ensure that patients are given the correct medication and can provide support for patients and their relatives or caregivers to prevent lapses in treatment. The TB nurse specialist can help to manage side-effects or drug formulations, take routine blood samples or occasionally arrange admission to hospital. (September, “The treatment of patients with TB and the role of the nurse.” n.d)

On the CDC website it can be found, that the vital role of public health nurse within the fight of Tuberculosis is to planning, coordinating, and evaluating TB Control/prevention. The people within these roles will need the state and local health departments to create a point of convergence and provide oversight.

• The planning and development of policy

• Event investigation

• Clinical diagnostic services for people with Tuberculosis along with the people they have contacted

• Training and education

• Surveillance data with information management

• Monitoring and evaluation.

The National Tuberculosis Controllers Association (NTCA) is one of the national agency or organization that have dedicated themselves to the task of addressing the Tuberculosis epidemic. “The National Tuberculosis Controllers Association (NTCA) was founded in 1995 in Atlanta, Georgia. It has guidance from the Centers for Disease Control and Prevention’s (CDC) Division of Tuberculosis Elimination (DTBE). Their mission is to advance the elimination of TB within the United States and its territories. They plan on doing this by the collective, concerted action of state, local, and territorial governments. These governing bodies are empowered by their jurisdictions with the responsibility and should carry out programs to prevent and control TB. The NTCA works closely with DTBE in mutual consultations, joint committees, and projects. The NTCA also sit on the CDC Advisory Council to Eliminate Tuberculosis. The NTCA has other partners are the American Thoracic Society, Stop TB USA, the American Lung Association, the Association of Public Health Laboratories, Infectious Disease Society of America, Council of State and Territorial Epidemiologists, Results International, and National Association of State and Territorial AIDS Directors. The NTCA also participates in and also supports the following annual Regional Tuberculosis Controllers Meetings: ” (CDC, 2017)

• Northern Rocky Mountain TB Controllers
•  California TB Controllers
• Upper Midwestern TB Controllers
• Southeastern TB Controllers
• Northeastern TB Controllers
• Southwestern TB Controllers
• Pacific Island TB Controllers.

The global implication of Tuberculosis shows that about two billion people are infected with this disease and one million eight hundred thousand will die yearly, which makes TB the leading infectious disease in the world. Of the ten million four hundred thousand people who become sick with TB annually. There are approximately four million people that are “missed” each year by health systems and do not get the care they need. This is what allows the disease to continue to be transmitted. Certain resistant strains of TD have developed they can’t be destroyed by anti-TB drugs. This is a result of the misuse or mismanagement of the drugs. When patients decide not to complete their full course treatment or when health-care providers prescribe the wrong treatment. Sometimes the wrong dose, or length of time for taking the drugs can also cause résistance. Also when the supply of needed drugs are not readily available; or when the drugs are of poor quality. Multidrug-resistant tuberculosis (MDR-TB) is TB resistant to two of the most important drugs used to treat TB: Isoniazid (INH) and Rifampin (RIF). Extensively drug-resistant TB (XDR-TB) is a rare type of MDR-TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR-TB is resistant to the most potent TB drugs, patients are left with treatment options that are much less effective. XDR-TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB. (CDC, 2017) The TB epidemic is being addressed in part by the CDC. They are working with Ministries of Health in more than 25 high burden countries to find a cure, and prevent TB and enhance global efforts. Through a unique combination of scientific and on-the-ground expertise, CDC is accelerating progress against this epidemic worldwide. (CDC, 2017)

References

• 2017 National Notifiable Conditions (Historical). (n.d.). Retrieved from https://wwwn.cdc.gov/nndss/conditions/notifiable/2017/
• Hargreaves, J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2011, April). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052350/
• Mandal, A. (2018, August 23). What is Tuberculosis? Retrieved from https://www.news-medical.net/health/What-is-Tuberculosis.aspx
• Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. St. Louis: Elsevier/Saunders.
• Public health surveillance. (2017, September 19). Retrieved from http://www.who.int/topics/public_health_surveillance/en/
• September, 2. 7. (n.d.). The treatment of patients with TB and the role of the nurse. Retrieved from https://www.nursingtimes.net/the-treatment-of-patients-with-tb-and-the-role-of-the-nurse/204131.article
• Tuberculosis (TB). (n.d.). Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/cdna-song-tuberculosis
• Tuberculosis. (2018, January 04). Retrieved from https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
• Tuberculosis: History. (n.d.). Retrieved from https://www.nationaljewish.org/conditions/tuberculosis-tb/history
• Tuberculosis. (n.d.). Retrieved from http://www.who.int/news-room/fact-sheets/detail/tuberculosis