World TB Day brings awareness to still relevant disease

Capt. Michelle Ambersley,
WBAMC:

World TB Day raises awareness about the global epidemic of tuberculosis Saturday in an effort to eliminate the disease. World TB Day commemorates the anniversary in 1882 when Dr. Robert Koch amazed the scientific community by announcing that he had discovered the cause of tuberculosis bacteria.

Tuberculosis is one of the world’s deadliest diseases. In 2010, nearly nine million people around the world became sick with TB and an estimated 1.4 million TB related deaths worldwide are reported annually.

Tuberculosis is an airborne infectious disease caused by a bacterium called mycobacterium tuberculosis. TB is both preventable and curable. People ill with active tuberculosis disease in their throat or lungs can infect others by talking, singing, coughing or sneezing near other people. If not treated, each person with active TB will infect on average between 10 and 15 people every year.

In 2010, there were 8.8 million new TB cases worldwide and 1.1 million people died from TB. In 2010, the U.S. reported 11,182 cases of TB and of those 1,385 were in Texas. El Paso reported 48 cases.

The TB rate, however, is going down in the U.S. due largely to the strategic plan put into effect after the U.S. experienced a resurgence of TB in the late 1980s.

The resurgence of tuberculosis has been attributed to the increasing incidence of HIV infection, in-hospital transmission of TB, multidrug resistant TB and increased immigration from countries with high incidence of TB.

Today, the U.S. continues to strive for the elimination of TB. Not everyone infected with the tuberculosis bacteria develops the active TB disease. Overall, between 5 to 10 percent of infected people will develop active TB disease at some time in their lives. About half of those people who develop active TB will do so within the first two years of infection. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing active TB disease is considerably higher than for persons with normal immune systems.

If active TB is detected early and successfully treated, people with the disease quickly become non-infectious and are eventually cured. Active TB can be prevented by treating the TB infection. This condition is also referred to as latent TB infection or LTBI. For most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with LTBI do not feel sick and do not have any symptoms. One method to detect if an individual has been exposed to TB bacteria is to administer a TST “mantoux” tuberculin skin test. A new standard in diagnosing TB infection is now available called the Interferon-gamma release assays or Quantiferon TB Gold test. The IGRAs are blood tests that detect TB infection with significantly higher specificity and sensitivity than the TST.

People with LTBI are not infectious and cannot spread TB bacteria to others. However, if LTBI is not treated, individuals may develop active TB disease. Once a person has active TB, they can infect others around them, especially close contacts like family members, roommates and co-workers. Symptoms of active TB include fever, chills, night sweats, prolonged cough, coughing up blood, loss of appetite, weight loss and fatigue.

These symptoms may also be associated with other illnesses like the flu; thus, a medical evaluation to include your past medical history, travel history to include deployments, place of birth and work history is important to accurately assess a person’s risk for active TB disease.

The WBAMC Army Public Health Nursing is open Monday through Friday, from 7:30 a.m. to 4:30 p.m. in the Soldier Family Care Center, 11335 SSG Sims Road, East Fort Bliss, second floor, Preventive Medicine Department. They can be reached by telephone at 742-1343.

What can we do as Fort Bliss stakeholders to eliminate TB within our community?

• Individuals with a history of a positive TST should seek a medical evaluation to assess risk and discuss treatments. Referrals can be sent to Community Health Nursing, or individuals can call 742-1343/1359/1355 to schedule an appointment.

• If you are undergoing treatment for LTBI or for active TB, make a commitment to continue treatment until you are successfully treated.

• If you are at high risk of active TB disease because you have an illness or are on medication that lowers your body’s defenses against disease (for example post-transplant, persons on prolonged corticosteroids, HIV, leukemia, cancer of the head and neck or silicosis), you are encouraged to get evaluated for TB by getting a TST. Individuals with diabetes, severe kidney disease, low body weight and those that have substance abuse problems may also be at higher risk of developing active TB disease.

If you know you have been exposed to someone that is sick with active TB, you are encouraged to get a medical evaluation for a TST. Infants and young children are particularly at high risk if they have been exposed to a close contact that is sick with active TB disease. Be aware of symptoms of active TB (prolonged cough, coughing up blood, fever, chills, night sweats, loss of appetite, weight loss and fatigue). Individuals that would like to have a TB test done can go to the immunization clinic or a local health department.

For references and more information, visit Centers for Disease Control and Prevention, Division for TB Elimination at www.cdc.gov/tb, World Health Organization at www.who.int/tb/en and Cellestis at www.cellestis.com.

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