Traveling has become a common activity for many and today people are no longer destined to stay on only one continent. Further, the ease and affordability of travelling has made it easy to spread diseases as opposed to the past. Tuberculosis is one of the diseases whose spread is highly fuelled by travelling.
Tuberculosis has been around since ancient times. Initially, it was referred to as Consumption in the past because it causes weight loss. Approximately a third of people in the world have been exposed and have tuberculosis despite the advances in medical diagnostics, screening and treatments. TB is spread when one stays close to an infected person for a significant period of time.
Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. The Mycobacterium tuberculosis which causes TB is hydrophobic, grows slowly and rod-shaped. The bacterium was first isolated and marked as an infectious disease by Robert Koch in 1882.
Basically, tuberculosis can either be active TB or latent TB. Symptoms of active TB include fatigue, fever, night sweats, loss of appetite, loss of weight, persistent cough and hemoptysis. Patients who suffer from latent tuberculosis are not contagious and are not able to spread the Mycobacterium tuberculosis to other people. Latent TB infection occurs when a person becomes infected with TB, but the immune system blocks off the bacterium from causing damage. Instead of causing damage to the body, it becomes dormant. It is recommended that TB should be treated at this stage to prevent it from developing into active TB.
Tuberculosis is transmitted through contact with droplets of infected persons, usually mucous or saliva. These droplets are expelled into the air when an infected person having active TB talks, sneezes or coughs. When these droplets get into the air, they remain suspended for many hours, and can be inhaled by anyone around that area. The actual infection occurs when these infected droplets reach alveoli in the lungs.
If not diagnosed or treated, tuberculosis spreads to other parts of the body through the bloodstream and finally affects both kidney and liver functions. In addition, it affects hips, knees and sometimes the spine by causing swelling and stiffness. In serious cases, tuberculosis affects tissues that surround the heart and brain’s membrane, leading to fatality. Tuberculosis is generally fotal is not properly handled. However, it is preventable.
For TB treatment, following treatment protocols is the biggest concern. Patient education is highly critical concerning compliance to medication and their side effects, seeking professional help, isolation and control measures. There are currently ten drugs that the Food and Drug Administration has approved for TB treatment.
Tuberculosis as a disease is found everywhere in the world. It mainly infects young adults, but all age groups can contract it. In 2013, more than 500,000 children got infected with tuberculosis. In the same year, 56% new TB cases occurred in Western Pacific and Southeast Asia areas. The estimated annual cases of new TB infections is falling coupled with decreasing death rate of 40% from 1990 to 2013. During the same period, 37 million lives were saved as a result of early diagnosis and treatment.
There are many factors that can increase a person’s risk of TB infection such as travel habits and residence. For example, places such as Russia, China, Africa and India have higher percentage of forms of TB that are resistant to most drugs. Also, situations where people are crowded can increase a person’s risk of contracting TB. These include prisons, nursing camps and homeless camps. People who live in low income areas are also at higher risk because they lack medical facilities and professional to help in the diagnosis and treatment of TB. Another factor that increases risk is substance abuse.
The epidemiologic triangle is a model describing disease causation. Understanding the function and relationship between factors enables the prevention of communicable disease. The three main factors are host, agent, and environmental. The image below is an example.
The host factors are affected by characteristics including age, health status, susceptibility, natural and artificial immunities, and many diseases. These factors influence a pathogen’s success at creating an infection. People with HIV are twenty-six to thirty-one times more likely to develop active TB than those not HIV positive. Natural, passive and artificial immunities are ways the body protects the host.
An agent is the pathogen or cause of the infection. Each pathogen has characteristics which enable it to successfully infect a host. Some of these characteristics include the ability to survive outside the body, susceptibility to antibiotics, transmission ability, degree of invasiveness, and the infective dose. Agents that are less infectious such as TB require host exposure to larger numbers of TB bacilli for longer periods for disease transmission.
Environment altering can affect a pathogen’s ability to spread disease. The transmission of infectious disease can be decreased by changing temperature, humidity, and ventilation. Crowding, famine, and mobility of people increase the possibility of spreading infections. Population density can contribute to environmental problems as it provides agents’ access to many victims rather than a few in a confined area.
Community health nurses work to prevent infection and spread of communicable diseases. They are often first to diagnose communicable disease and are tasked with interviewing the infected person. This identifies further community members at risk due to infected patient contact. They perform home visits to assess patients under treatment and safeguard compliance.
Preventions are risk reduction activities to the population’s health. Primary prevention actions prevent disease establishment and focus on risk reduction, health education, and vaccination. Secondary prevention focuses on reducing a disease’s impact by detecting further disease cases and treating known cases to slow or stop disease progression, at the earliest stages so people can return to their normal health and functional levels as soon as possible. Tertiary prevention involves actions to manage diseases’ long-term effects and accompanying health problems, and the creation of programs and plans to improve the function, quality of life of those infected with disease.
Case finding identifies every case of possible disease. When new cases are identified, rapid treatment occurs to minimize further transmission. Community health nurses often function as case finders. Nurses identify individuals with the most intimate contact, referred to as Level One contacts. The search continues to spread outward in a circular fashion to others in close contact known as Level Two contacts. In cases where no further infections are found in Level One, there is no reason to proceed to Level Two.
In the United States, some diseases are required to be reported by state and local health departments. State public health departments are legally responsible for controlling communicable diseases within their state and reporting approximately ninety notifiable communicable diseases to the CDC. Most states electronically report their cases to the CDC.
Data collection enables the CDC and individual states to decide which health concerns should have priority. This data collection shows seasonal fluctuations and geographic distributions or higher incidences in selected risk groups of the disease being tracked. Trends are noted while programs are formulated to prevent or reduce a disease’s impact. An example involves measles’ resurgence as researchers discovered combined measles-mumps-rubella vaccine was not as long-acting as previously believed. New immunization standards were developed as a result.
The community health nurse is responsible for follow-up with patients who have a communicable disease to see if they are continuing their medications, health is improving, and if there are any areas needing education. Follow-up is especially important with tuberculosis patients that are not compliant taking medications because there is increased risk of antibiotic resistant TB.
The World Health Organization has developed multiple programs over the years to decrease the number of TB cases and hopefully to end TB worldwide. One initiative of the WHO was to expand high quality Directly Observed Treatment Short-course therapy for TB cases. DOTS is treatment regimen directly observed by a community health worker for at least the first two months. Other TB objectives of WHO include high-quality care for all with TB, reduce suffering and socioeconomic burden associated with TB, protecting vulnerable populations from TB, TB/HIV and multidrug-resistant TB, and to protect and promote human rights in TB prevention, care and control.
Worldwide tuberculosis deaths each year are second only to HIV in number. There is an estimated need for eight million dollars annually to fund a full response to TB in low and middle income countries. More than fifty companies are involved in the development of improved TB diagnostics and there are fifteen vaccines currently in trials. While the number of TB cases is decreasing, there is more work to be done.
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